Hypermobility - exam 2 Flashcards
true or false. hypermobility is less common in LE
true
more stable due to depth of socket
what are traumatic causes of hypermobility?
fx and ligamentous tear
labral tear
what are atraumatic causes of hypermobility?
extreme motions in sports
labral tear with FAI/IPI
systemic connective tissue disorder
bone abnormality
what are bone abnormalities that could cause hypermobility?
shallow acetabulum
inferior acetabular insufficiency
excessive femoral version or torsion (only one you can pick up on clinically)
excessive femoral neck angle
what is femoral torsion?
in transverse plane, the angle between femoral condyles and femoral head and neck
–> femur gets twisted
what is excessive anteversion?
excessive retroversion?
toeing in
toeing out
what is femoral neck angle?
in the frontal plane, the angle between the shaft and neck
coxa valga:
- _______ angle of inclination
- leads to ________
larger
genu vara or bow legged position
coxa vara:
- _______ angle of inclination
- leads to _______
smaller
genu valga or knock kneed position
prevalence of hypermobility?
inconsistent gender differences
5-35% of those with hip joint P!
risk factors of hypermobility?
genetics
injury
nature of pt’s activities:
– running, ballet, golf, hockey, soccer
– excessive rotation, flexion & hyperextension
what are symptoms of hypermobility?
like impingement due to hypermobility plus:
- anterior groin or lateral hip P!
- popping, locking, snapping present
- feeling of instability, esp when squatting
hypermobility signs:
- ROM:
- combined motions:
- special tests:
- hip IR > 30 deg at 90 deg flx
- possible inconsistent block
- hip apprehension, abnormal femoral version or torsion
what is the hip apprehension special test?
in prone move hip into ext w ER and ABD while applying ant inf force on femur
specific to pubofemoral ligament test
what is the primary focus for Rx of hypermobility?
cartilage integrity and stabilization
local muscles of hip: piriformis, quadratus femoris, obturator externus/internus
what are the signs of hypermobility?
- ROM
-CM
like impingement due to hypermobility plus:
-ROM: hip IR >30º @ 90º flx
-CM: possible inconsistent block
what are the special test for hypermobility?
hip apprehension - in prone move hip into EXT w/ ER and aBd while applying antinf force on femur (specific to pubofemroal ligament test)
Abnormal femoral version or torsion
PT Rx: primary focus
cartilage integrity and stabilixaation
What are hip local mm’s.
glute med
piriformis
GOGOs
Quadraters Femoris
what is regional interdependence?
a theory that different body regions are ______________ and ________________ interdependent and
__________ may play a role
biomechanically; neurophysiological;
impairment in one region can contribute to impairment in another, particularly if persistent.
central mechanism (motor cortex)
-The predominant innervation to the ____________Z jts. is the _______ dorsal rami
-Predominant and MOST consistent innervation to ________ disc are the _____ dorsal root ganglia and the ________ and ______ sinuvertebral nn.
-Illiolumbar ligaments are innervated by ______ spinal nn.
L4-S1; L4
L4-S1 discs; L1-2; L4-5
L1-4 (sensory & motor)
If any of the L4-S1 joints are persistently hypermobile/unstable which mm. groups are more likely to excessively recruit due to the predominance of L1-L4 innervation & sensation
Hip Flexors (L1,2)
Hip aDductors (L3)
Knee Extensors (L3-4)
Ankle DFs (L4,5)
What are the hip muscles and their spinal innervation that can assist w/excessive recruitment?
Illiopsas (L1-4)
Illiocapuslaris (L2-4)
Rectus Femoris (L2-4)
What is the iliopsoas function and attachment?
primarily a hip flexor and trunk stabilizer; illiocapsularis
What is the illiocapsularis function and attachment?
primarily a dynamic stabilizer for capsule also hip flexor; attaches to the illiopsaos, anteromedial capsule, and rectus femoris
What is the rectus femoris attachment?
attaches to the capsule
The capsule attached to the _______
labrum
Etiology of L4 -S1 regional interdependence
L4-S1 hyper/instability
MOST common segements
regional interdependence Pathomechanics:
—excessive recruitment of
–inhibition of ________ & ________
hip flexors that attach capsule and labrum
extensors and abductors
Excessive recruitment of the hip flexors that attach to capsule and labrum can lead to
–excessive traction on ________ portion of capsule and labrum
–may lead to labral ________ without _________ changes like with FAI
3 o’clock & 9 o’clock (depending on hip)
attrition; bony
Imbalance limits optimal __________ and ________
Easily overworked due to ______________ so overuse/lower supply occurs
axis of motion and jt. support
lowered recruitment
Hypertonicity of hip extensors and abductors :
–due to being __________ even without __________
—protection @ ______ and is often reported as ___________ that is stretching temporarily helps but does not resolve
overworked; overuse
rest; “tightness”
_______ is a stabilizer of the lordosis in sitting
iliopsoas
____________maintain size or even hypertrophies in those with LBP (indicating cont. & excessive recruitment)
iliopsoas
An excessively recruited iliopsoas can further add to ___________ shearing MOST often occurring with lumbar hyper/instability
anterior
What is iliopsoas impingement?
Impingement without dysplasia or bony changes:
iliopsoas impingement: etiology
not fully clear
condition that lead to excessive hip flexor recruitment
lumbar hyper/instability
iliopsoas impingement: symptoms
like FAI
possible hyper/instability
IPI ROM could have _____ limitation at 90 deg flexion due to ___?
end feel?
IR limitation
due to inhibition and hypertonicity of extensors or primarily GMax (Main ER at 90 deg flex)
elastic end feel
someone with IPI could have hip ______ at 90 deg flex. explain what this is and what it is due to
end feel?
maltracking - hip deviates into abd while passively flexing
due to inhibition and hypertonicity of piriformis that is an abductor at 90 deg flex
elastic end feel into flex if deviation not allowed
what is possibly inhibited with resisted testing with IPI?
hip ER inhibition at 90 deg flex due to Gmax inhibition (main ER at 90 deg flex)
inhibition of extensors, including quad dominant squatting pattern (hip ext inhibited knee ext excessively recruiting)
inhibited abductors
neuro signs of IPI:
possible hypersensitivity
where would you experience TTP in someone with IPI?
over ant hip region at 3 or 9 o clock position depending on hip
PT Rx for IPI
culprit rx: for lumbar hypermobility
victim rx: FAI Rx (labrum integrity, mm around hip)
MD Rx for IPI
iliopsoas surgical release
