Hypermobility - exam 2

Question 1

true or false. hypermobility is less common in LE

Answer 1

true
more stable due to depth of socket

Question 2

what are traumatic causes of hypermobility?

Answer 2

fx and ligamentous tear
labral tear

Question 3

what are atraumatic causes of hypermobility?

Answer 3

extreme motions in sports
labral tear with FAI/IPI
systemic connective tissue disorder
bone abnormality

Question 4

what are bone abnormalities that could cause hypermobility?

Answer 4

shallow acetabulum
inferior acetabular insufficiency
excessive femoral version or torsion (only one you can pick up on clinically)
excessive femoral neck angle

Question 5

what is femoral torsion?

Answer 5

in transverse plane, the angle between femoral condyles and femoral head and neck
–> femur gets twisted

Question 6

what is excessive anteversion?
excessive retroversion?

Answer 6

toeing in
toeing out

Question 7

what is femoral neck angle?

Answer 7

in the frontal plane, the angle between the shaft and neck

Question 8

coxa valga:
- _______ angle of inclination
- leads to ________

Answer 8

larger
genu vara or bow legged position

Question 9

coxa vara:
- _______ angle of inclination
- leads to _______

Answer 9

smaller
genu valga or knock kneed position

Question 10

prevalence of hypermobility?

Answer 10

inconsistent gender differences
5-35% of those with hip joint P!

Question 11

risk factors of hypermobility?

Answer 11

genetics
injury
nature of pt’s activities:
– running, ballet, golf, hockey, soccer
– excessive rotation, flexion & hyperextension

Question 12

what are symptoms of hypermobility?

Answer 12

like impingement due to hypermobility plus:
- anterior groin or lateral hip P!
- popping, locking, snapping present
- feeling of instability, esp when squatting

Question 13

hypermobility signs:
- ROM:
- combined motions:
- special tests:

Answer 13

• hip IR > 30 deg at 90 deg flx
• possible inconsistent block
• hip apprehension, abnormal femoral version or torsion

Question 14

what is the hip apprehension special test?

Answer 14

in prone move hip into ext w ER and ABD while applying ant inf force on femur

specific to pubofemoral ligament test

Question 15

what is the primary focus for Rx of hypermobility?

Answer 15

cartilage integrity and stabilization

local muscles of hip: piriformis, quadratus femoris, obturator externus/internus

Question 16

what are the signs of hypermobility?
- ROM
-CM

Answer 16

like impingement due to hypermobility plus:
-ROM: hip IR >30º @ 90º flx
-CM: possible inconsistent block

Question 17

what are the special test for hypermobility?

Answer 17

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

Question 18

PT Rx: primary focus

Answer 18

cartilage integrity and stabilixaation

Question 19

What are hip local mm’s.

Answer 19

glute med
piriformis
GOGOs
Quadraters Femoris

Question 20

what is regional interdependence?
a theory that different body regions are ______________ and ________________ interdependent and

__________ may play a role

Answer 20

biomechanically; neurophysiological;

impairment in one region can contribute to impairment in another, particularly if persistent.

central mechanism (motor cortex)

Question 21

-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.

Answer 21

L4-S1; L4
L4-S1 discs; L1-2; L4-5
L1-4 (sensory & motor)

Question 22

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

Answer 22

Hip Flexors (L1,2)
Hip aDductors (L3)
Knee Extensors (L3-4)
Ankle DFs (L4,5)

Question 23

What are the hip muscles and their spinal innervation that can assist w/excessive recruitment?

Answer 23

Illiopsas (L1-4)
Illiocapuslaris (L2-4)
Rectus Femoris (L2-4)

Question 24

What is the iliopsoas function and attachment?

Answer 24

primarily a hip flexor and trunk stabilizer; illiocapsularis

Question 25

What is the illiocapsularis function and attachment?

Answer 25

primarily a dynamic stabilizer for capsule also hip flexor; attaches to the illiopsaos, anteromedial capsule, and rectus femoris

Question 26

What is the rectus femoris attachment?

Answer 26

attaches to the capsule

Question 27

The capsule attached to the _______

Answer 27

labrum

Question 28

Etiology of L4 -S1 regional interdependence

Answer 28

L4-S1 hyper/instability
MOST common segements

Question 29

regional interdependence Pathomechanics:
—excessive recruitment of
–inhibition of ________ & ________

Answer 29

hip flexors that attach capsule and labrum
extensors and abductors

Question 30

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

Answer 30

3 o’clock & 9 o’clock (depending on hip)
attrition; bony

Question 31

Imbalance limits optimal __________ and ________
Easily overworked due to ______________ so overuse/lower supply occurs

Answer 31

axis of motion and jt. support
lowered recruitment

Question 32

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

Answer 32

overworked; overuse
rest; “tightness”

Question 33

_______ is a stabilizer of the lordosis in sitting

Answer 33

iliopsoas

Question 34

____________maintain size or even hypertrophies in those with LBP (indicating cont. & excessive recruitment)

Answer 34

iliopsoas

Question 35

An excessively recruited iliopsoas can further add to ___________ shearing MOST often occurring with lumbar hyper/instability

Answer 35

anterior

Question 36

What is iliopsoas impingement?

Answer 36

Impingement without dysplasia or bony changes:

Question 37

iliopsoas impingement: etiology

Answer 37

not fully clear
condition that lead to excessive hip flexor recruitment
lumbar hyper/instability

Question 38

iliopsoas impingement: symptoms

Answer 38

like FAI
possible hyper/instability

Question 39

IPI ROM could have _____ limitation at 90 deg flexion due to ___?
end feel?

Answer 39

IR limitation
due to inhibition and hypertonicity of extensors or primarily GMax (Main ER at 90 deg flex)
elastic end feel

Question 40

someone with IPI could have hip ______ at 90 deg flex. explain what this is and what it is due to
end feel?

Answer 40

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

Question 41

what is possibly inhibited with resisted testing with IPI?

Answer 41

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

Question 42

neuro signs of IPI:

Answer 42

possible hypersensitivity

Question 43

where would you experience TTP in someone with IPI?

Answer 43

over ant hip region at 3 or 9 o clock position depending on hip

Question 44

PT Rx for IPI

Answer 44

culprit rx: for lumbar hypermobility
victim rx: FAI Rx (labrum integrity, mm around hip)

Question 45

MD Rx for IPI

Answer 45

iliopsoas surgical release