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KIN 3160 > Hip & thigh injuries > Flashcards

Hip & thigh injuries Flashcards

1
Q

muscle strains - MOI

A
  • explosive concentric contraction
  • quick start/stop, change of direction
  • eccentric contraction - lengthening; some muscles do two different actions simultaneously at two different joints
  • overstretching

contributing factors: fatigue, pelvic asymmetry, strength imbalance, leg length discrepancy, muscle tightness

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2
Q

muscle strains can occur acutely or chronically, why?

A

-can become a chronic issue if there is no rest, during the repair process, scar tissue forms (creates a weak point in muscle)

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3
Q

muscle strains: S&S

A
  • point tenderness with a palpable spasm
  • possible palpable defect or divot
  • bruising may or may not be present
  • pain increases with AROM or IR testing
  • PROM painful at end ROM when on stretch
  • level of dysfunction or disability depends on severity of the injury
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4
Q

grade 1 muscle strain

A

minimal, few fibers torn, minor swelling

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5
Q

grade 2/3 muscle strain

A

complete rupture, more edema than grade 1

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6
Q

quadriceps muscle strain

A
  • most common in rectus femoris
  • possible avulsion fracture of AIIS
  • vulnerable when hip extended and knee flexed
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7
Q

hamstrings muscle strain

A
  • most commonly strained muscle in the body
  • vulnerable with hip flexion and knee extension
  • deceleration of leg swing
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8
Q

adductor muscle strains

A
  • adductor longus most commonly injured

- adductor magnus presents similar to hamstring pain

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9
Q

hip flexor muscle strain

A
  • sprinting or kicking MOI (unplanar movement)

- often tight due to seated posture

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10
Q

which special test is used to determine hip flexor muscle strains?

A 
Thomas test (for hip flexors and quads)
-looking to see where the quad is lying; someone with tight hip flexors will be above horizontal plane
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11
Q

initial management for muscle strain

A
  • POLICE - tensor wrap/compression shorts, activity modification but early return to walk (want to engage muscle a bit; avoid intense activities)
  • should not RTP until full ROM and strength - will feel a lot better before they actually have the strength needed to return
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12
Q

what types of therapy can be used to manage muscle strains after the initial treatment

A
  • initially - gentle stretching, ROM and early contraction activation (isometric)
  • address underlying causes (pelvis, muscle asymmetries)
  • later - strengthening and functional exercises (eccentric and plyometric)
  • testing in controlled environment before RTP

severe strain or rupture may require surgical intervention (grade 3)

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13
Q

quadriceps contusion MOI

A

direct blow to anterior or anterolateral thigh

-compression force between soft tissue and femur

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14
Q

S&S of quadriceps contusion

A

transitory loss of function/weakness and immediate bleeding; increased pain with AROM knee extension and hip flexion; PROM of knee flexion limited

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15
Q

which special test is used to diagnose quad contusion?

A

Ely’s test
-look at quad length; prone, bend person’s knee and see what happens at hip, if hip hikes up - tension in the quad; if hip is neutral, good length of quad

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16
Q

management of quad contusion

A
  • POLICE - put the knee in max flexion and crutches - prevent stiffness, heal in length position
  • therapy - gentle stretching and ROM (avoid soft tissue therapy - massage; RTP - pad and protect)
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17
Q

what is a secondary complication of a quadriceps contusion?

A

myositis ossificans

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18
Q

sciatica - def

A

any condition that causes irritation to the sciatic nerve including disk herniation in the low back, direct trauma (ex: hard fall), piriformis muscle compression

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19
Q

the sciatic nerve is a continuation of the _____ and travels through the _____

A

sacral plexus, greater sciatic notch

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20
Q

the sciatic nerve passes through the piriformis in ___% of the population

A

15

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21
Q

S&S of piriformis syndrome

A
  • deep, dull ache in mid-buttock without pain
  • numbness and tingling may extend down back of thigh and leg (further it travels down, the more severe it is considered)
  • pain on palpation of sciatic notch/piriformis
  • NEED to rule out disc herniation (straight leg raise test, coughing)
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22
Q

management of piriformis syndrome

A
  • stretching, massage (trigger point or STRP - soft tissue release) (abduction, internal rotation)
  • acupuncture has been known to provide relief from symptoms
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23
Q

hip dislocation MOI

A
  • rare in sports

- traumatic force along the long axis of the femur when knee is flexed (MVA)

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24
Q

S&S of hip dislocation

A

-flexed, adducted, and internal rotated thigh

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25
Q

secondary complications of hip dislocation

A

capsular and ligamentous strains, fractures, sciatic nerve impingement, disruption of femoral head blood supply

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26
Q

management of hip dislocation

A

911 monitor vitals, treat shock and immobilize in position found

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27
Q

therapy for hip dislocation

A

immobilization (bed rest), crutches, progressive ROM exercises

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28
Q

labral tear MOI

A
  • acute: hip dislocation

- chronic: increased joint stresses (deep squats) or repetitive movements cause degeneration

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29
Q

S&S of labral tear

A
  • commonly asymptomatic
  • catching, locking, or clicking in hip
  • pain in hip/groin
  • stiffness/limited ROM
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30
Q

what are the special tests to diagnose labral tears?

A
  • FABER (flexion, abduction, external rotation)
  • flex-IR
  • scouring
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31
Q

management for labral tears

A
  • hip ROM, strengthening and stability exercises
  • avoid painful movements/positions
  • surgery to remove or repair
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32
Q

avascular necrosis - def

A

temporary or permanent loss of blood to proximal femur

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33
Q

causes of avascular necrosis

A
  • hip dislocation

- lateral circumflex artery compromised

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34
Q

Legg-Calve-Perthes disease

A
  • children 4-10 years
  • boys more often than girls
  • disruption to circulation to head of femur, articular cartilage necrotic and flattens
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35
Q

S&S of avascular necrosis

A
  • gradual onset pain
  • initially only with WB, progresses to even when at rest
  • pain in groin, with referral to abdomen and knee (kinetic chain)
  • limited ROM and antalgic gait (limp)
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36
Q

management of avascular necrosis

A
  • NWB (bed rest or hip brace, if caught early)
  • early treatment = femur vascularizes and re-ossifies
  • complications = femur remains deformed, develop OA (later in life), and surgical repair
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37
Q

which type of bursitis is most common?

A

trochanteric

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38
Q

bursitis - MOI

A

-excessive friction or shear forces (repetitive stress) or direct blow (not a lot of muscle here)

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39
Q

bursitis - S&S

A

-burning or aching sensation over/posterior to greater trochanter which is aggravated by hip abduction (especially against resistance), hip flexion and extension while WB

40
Q

which special test is used to diagnose bursitis?

A

Obler’s test

  • TFL and ITB tightness
  • bring hip back, then let leg hang off table - horizontal position indicates tension
41
Q

management of bursitis

A

-POLICE and activity modification

42
Q

therapy for bursitis

A
  • stretching program and manual therapy (myofascial release) - IT band stretch
  • later on strengthening exercises for the hip
  • meds - NSAIDs or injections
  • biomechanical analysis of training techniques, posture, and gait to identify contributory intrinsic factors (leg length discrepancy)
43
Q

femoral fractures - MOI

A
  • tremendous impact forces or direct compressive forces
  • more common in middle aged or elderly
  • can be very serious bc of potential damage to neurovascular structure (femoral artery, sciatic nerve)
44
Q

S&S of femoral fracture

A
  • extreme pain
  • inability or unwillingness to move
  • deformity or gross instability (crepitus)
  • leg appears shortened and held in ER and ABD (neck); shortened and ER (shaft)

-monitor for S&S of shock

45
Q

management of femoral fractures

A
  • 911
  • manually stabilize in position found; monitor vital signs (especially distal MSC)
  • monitor and treat for shock
  • EMS - traction splint applied, along with pain meds
46
Q

how common are femoral stress fractures?

A
  • femoral neck = uncommon
  • more prevalent due to popularity of repetitive, sustained activities - ex: marathon runners
  • more common in amenorrhoeic women
47
Q

S&S of femoral stress fracture

A
  • gradual onset of pain in groin or anterior thigh with activity
  • eventually constant pain and antalgic gain
48
Q

management of femoral stress fractures

A
  • conservative (21 weeks)
  • better success rate for medial side of femoral neck (compression)
  • surgery after about 12 months
49
Q

slipped capital femoral epiphysis is most common in who?

A
  • tall boys 10-17 years (thin or obese)

- related to growth hormones

50
Q

slipped capital femoral epiphysis - MOI

A

trauma or prolonged stress

51
Q

S&S of slipped capital femoral epiphysis

A

initially minimal, progress to hip and knee pain with AROM and PROM; limited abduction, flexion, and medial rotation; limp

52
Q

management of slipped capital femoral epiphysis

A
  • minor slippage - NWB
  • major slippage - surgery
  • hip problems later in life if undetected or normal mechanics not restored
53
Q

MCL sprain - MOI

A
  • valgus force
  • from outside of the knee
  • lateral to medial
54
Q

S&S of MCL sprain

A

-localized swelling and instability - NO big balloon swelling like cruciate ligaments

55
Q

which special test is used to diagnose MCL sprains?

A

valgus stress test

  • to see how lax the ligament is
  • done at 0 and 30 deg flexion
56
Q

LCL sprain - MOI

A

varus force

57
Q

S&S of LCL sprain

A

localized swelling and instability

58
Q

which special test is used to diagnose LCL sprains

A

varus stress test

59
Q

which is more common? MCL sprain or LCL sprain?

A

MCL

60
Q

how long is the recovery for MCL/LCL sprains?

A

weeks (for grade 1)

-heals relatively well

61
Q

PCL sprain - MOI

A
  • hyperflexion with ankle in plantar flexion

- dashboard injury

62
Q

S&S of PCL sprain

A
  • joint swelling and instability

- not as much swelling as ACL

63
Q

which special test is used to diagnose PCL sprains?

A
  • posterior drawer test - knee in flex position, push on tibia posteriorly
  • posterior sag test - hips flexed, knees bent, see where tibial tubercle lies
64
Q

why should we test for PCL sprain before ACL sprain?

A

to prevent false negative in ACL diagnosis

65
Q

ACL sprain - MOI

A
  • varus force
  • also a rotary force - planting foot and twisting
  • typically non-contact mechanism
66
Q

S&S of ACL sprain

A

joint swelling and instability

-capsular swelling, sometimes not immediately

67
Q

which special test is used to diagnose ACL sprains?

A
  • anterior drawer test - test PCL first
  • Lachman drawer test - hamstrings a bit looser (do similar actions to ACL, need to be relaxed for tests)
  • pivot-shift test
68
Q

what is the terrible triad of the knee? which structures make this up?

A

ligaments that are torn most often, together

-ACL, MCL, medial meniscus

69
Q

why are females more susceptible to ACL injuries?

A

many risk factors:

  • environmental
  • anatomical - ex: Q-angle
  • hormonal - ex: contraceptives
  • neuromuscular (modifiable)
  • biomechanical (modifiable)
70
Q

what are the two types of ACL surgical reconstruction surgeries?

A

1) autographs
- patellar tendon bone
- hamstrings (SM and gracilis)
2) allographs
- from donor tissue bank (achilles or quad tendon)

71
Q

ACL prevention and rehabilitation strategies

A
  • strength
  • flexibility
  • balance/proprioception - movement correction
  • core stability
  • plyometrics
  • agility
  • jump landing

FIFA 11+ is one of the manu rehab programs available

72
Q

osteochondral fracture

A
  • fracture of articular cartilage and underlying bone
  • very impactful injury
  • WB surfaces (femur, tibia, posterior patella)
  • joint effusion, crepitus, and pain WB
73
Q

patellar fracture

A
  • forcible quadriceps contraction or direct impact

- general swelling

74
Q

patellar/quad tendon rupture MOI

A
  • sudden, powerful contraction of the quads

- usually secondary to tendon degeneration (tendinosis) - repetitive overuse

75
Q

S&S of patellar/quad tendon rupture

A
  • patella moves up thigh

- significant pain and swelling

76
Q

management of patellar/quad tendon rupture

A
  • surgical repair

- cannot treat only with exercise

77
Q

patellar subluxation/dislocation MOI

A
  • deceleration combined with cutting motion (valgus position)
  • quadriceps pulls straight, as a result pulls patella laterally
  • sometimes it shifts out and comes back in
  • lateral because valgus knee position
  • commonly associated with alignment issues
78
Q

S&S of patellar subluxation/dislocation

A
  • pain, swelling, and complete loss of function

- patella displaced laterally

79
Q

which special test is used to diagnose patellar subluxation/dislocation

A

aprehension test

80
Q

management of patellar subluxation/dialocation

A
  • splint and ice - do not attempt to reduce
  • refer to physician - requires X-ray; associated with osteochondral fracture
  • immobilization (4 weeks)
  • therapy: strengthen quads/stretch lateral retinaculum and ITB
  • add strength and stability to medial structures so it doesn’t go lateral again
  • brace for RTP
81
Q

quad/patellar tendinopathy “jumper’s knee”

A
  • repetitive or eccentric knee extension activities

- involving changing direction or jumping

82
Q

quad tendinitis - def

A

chronic inflammation at superior patellar pole

83
Q

patellar tendinitis

A
  • distal pole of patella
  • more common in younger population - bones grow and tendons have to catch up

when it results in tendon degeneration - tendinosis (no inflammation)

84
Q

quad/patellar tendinopathy management

A

Acute inflammatory phase - POLICE, ice and activity modification

Chronic inflammatory phase

  • correct any biomechanical issues
  • quad stretching and friction massage
  • eccentric quad strengthening - more forceful and function and sport specific

bracing or taping: chopat

85
Q

Apophysitis: osgood schlatter disease

A

-inflammation of the patellar ligament at the tibial tuberosity

86
Q

apophysitis: larsen johanson disease

A

juvenile osteochondrosis and traction epiphysitis affecting the extensor mechanism of the knee which disturbs the patella tendon attachment to the inferior pole of the patella

87
Q

in who is apophysitis common?

A

adolescents

  • pain and inflammation resolve at skeletal maturity
  • deformity remains
88
Q

what is a secondary complication of apophysitis?

A

avulsion fractures

89
Q

management of apophysitis

A
  • POLICE
  • rest for a period of time and avoidance of aggravated activities
  • can take a long time to resolve
  • stretch and strengthen quads and hams
90
Q

ITB friction syndrome - MOI

A
  • excessive compression against lateral femoral epicondyle

- genu varum and pronated feet

91
Q

S&S of ITB friction syndrome

A

achy pain in lateral knee aggravated by running or cycling; worsens with activity

92
Q

which special test is used to diagnose ITB friction syndrome?

A

Obler’s test

-lying on side, leg into abduction and extension and let leg hang

93
Q

management of ITB friction syndrome

A
  • cryotherapy and electrotherapy modalities
  • physician - NSAIDs or corticosteroid injections
  • therapy - stretching (gluts/TFL) and manual (massage, STR, MFR, and foam rolling); strengthening ER’s, ABD’s of the hip
  • correct pelvic or foot malalignments
94
Q

bursitis in the knee - MOI

A

-direct blow, overuse (friction caused by tight structures and repetitive movements or repetitive blows), infections, RA, tumours

95
Q

what are the most common forms of bursitis in the knee?

A

-pre-patellar (kneeling) and pes anserine (sartorius, gracilis, and semitendinosus; medial repetitive flexion/extension)

96
Q

S&S of bursitis in the knee

A

localized swelling, depends on where the bursal sad is located
-ask for MOI to distinguish from ACL injury, palpation, look at rectus femoris (Eli’s test), ROM

97
Q

management of bursitis in the knee

A
  • POLICE
  • physician - NSAIDs, pain relievers, may drain the bursal sac; surgery (bursectomy)
  • activity modification and protective knee pad
  • avoidance of kneeling or uneven running surfaces
  • therapy - ROM and flexibility
  • correct faulty mechanics

KIN 3160 (10 decks)

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