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Intro LE Hip and Knee > Intro LE Hip and Knee > Flashcards

Intro LE Hip and Knee Flashcards

1
Q

The head of the femur faces

A

Anterior / superior / medial

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2
Q

The acetabulum faces

A

Anterior / inferior / lateral

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3
Q

Normal neck of the femur angle

A

115 - 128 degrees

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4
Q

Anteversion vs retroversion degrees

A

Over 15 degrees is anteversion, increased angle

Less than 15 degrees is retroversion, decreased angle

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5
Q

4 sets of fibers of hip joint capsule

A
  1. Longitudinal: keep joint surfaces together
  2. Oblique: keep joint surfaces together
  3. Arcuate: only attach to acetabular ring
  4. Circular: no bony attachment
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6
Q

The hip joint capsule is strengthened anteriorly by what muscle

A

Deep fibers of Rectus femoris

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7
Q

What is the pulvinar acetabuli and its 3 functions

A

Fat pad in acetabular fossa

  1. Lubrication
  2. Shock absorption
  3. Protects lig teres
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8
Q

Name the 4 hip joint ligaments

A

Iliofemoral
Pubofemoral
Lig teres
Ischiofemoral

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9
Q

Ligamentum Teres function

A

As strong as ACL and provides stability

Contributes to vascular supply of femoral head, obturator artery runs through it

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10
Q

Iliofemoral lig resists

A

Strongest, extension

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11
Q

Pubofemoral ligament resists

A

Abduction and ER

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12
Q

Ischiofemoral ligament
Resists

A

ER, extension, abduction

(On posterior side)

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13
Q

The anterior and posterior hip ligaments wind in what direction

A

Clockwise

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14
Q

What movements winds hip ligaments

A

Extension

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15
Q

Which movement tightens anterior fibers of hip

A

ER

IR will tighten posterior fibers

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16
Q

Hip labrum functions

A

Increase SA by 28%

Creates negative intraarticular pressure for stability

Poor vascularization

Resists distraction

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17
Q

Hip Arthrokinematics

A

Flx/ext: spins
Abd: inferior
Add: superior
IR: post
ER: ant

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18
Q

Hip resting vs closed packed positions

A

Resting: 30 flx, 30 abd, 20 ER

Closed: extension, abduction, IR

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19
Q

Hip capsular pattern

A

Flx, abd, IR

*sometimes IR can be most limited but always is a mix of these 3

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20
Q

Hip AROM values

A

Flx: 120
Ext: 20
Abd: 45
Add: 30
IR: 30
ER: 45

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21
Q

What are the 6 hip ERs

A

Superior/Inferior gemelli
Obturator internus/externus
Piriformis
Quadratus femoris

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22
Q

Hip stress fractures symptoms

A

Pain in the groin and anterior thigh

Unable to run

+ trendelenberg, + heel drop

TTP femoral neck

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23
Q

Avascular Necrosis Hip symptoms

A

Sever night pain

If no improvement in 2-3 months, refer for MRI

Often missed on x ray first 4-5 months

History of long term steroid use, alcoholism, sickle cell, drug abuse

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24
Q

Hip metastasis symptoms

A

History of cancer (even 20-30 years ago)

2nd most common site for metastasis behind thoracic spine

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25
Hip OA incidence, symptoms, and gold standard diagnosis
10-25% of those over 55 Low irritability overall, morning stiffness less than 10 minutes, pain in groin, anterior thigh, lateral knee X-ray, classified by joint space narrowing, osteophytes, and subchondral bone alterations
26
CPRs for hip OA
1. Squatting causes pain 2. Active hip flexion causes pain 3. Active hip extension causes pain 4. Passive IR less than 25 degrees 5. Scour test with addiction creates lateral hip or groin pain
27
Treatment of hip OA
Manual, exercise, aerobic Manual has best outcomes and should be first choice Manual= manipulation and stretching
28
FAI of hip definition and 2 types
Overcoverage of femoral head from acetabulum Pincer and Cam
29
Pincer FAI definition
Acetabulum covers too much of the femoral head No potential for any real damage here
30
Cam FAI definition and prognosis
Femoral head more egg or cam shaped, not spherical causing abutment between acetabulum and femoral head leading to progressive cartilage erosion Precursor for labral tears and OA
31
With a cam, what 2 motions cause increased compression and shear into articular cartilage of hip
Flexion and IR
32
Does articular cartilage become damaged from shear or compression?
Shear
33
Hip joint pain anteriorly is most correlated with
Articular cartilage damage
34
Those with CAMs will like what motion
ER
35
Cam TX considerations
Don’t push end ranges of motion Surgical consult if having anterior hip pain Less IR = higher cam chance, less than 20 is concern Squats and leg presses less than 90 Activate ERs during activity Sit on wedge or adjustable chairs
36
Lig teres Strong as Tears
ACL Prevent excess motions when playing sports Tears will created excess flex and IR in patients
37
Lig teres test
Patient supine, flx knee to 90, flx hip to 70, then abduct hip as far as tolerable, then bring back into adduction until 30 shy of full abduction, fully IR and ER until reach firm endpoint + is pain with either IR and ER
38
Labral tears Found where in hip Sx
Anterior quadrant Pain in anterior hip, groin with clicking, popping and giving way
39
Labral tears diagnosis
Usually in active patients that sx are made worse by activity Radiographs to rule out dysplasia or degenerative MR arthrogram gold standard, then MRI/CT Small tears managed well conservatively but large require surgery
40
Most consistent exam finding for labral tears
Positive scour test
41
Hip joint hyper mobility and young
Now deemed a potential cause of pain and disability in young population
42
Hip joint hyper mobility categories
1. Bony abnormalities like dysplasia or FAI 2. Connective tissue disorders like ehlers Danlos, Marfans, downs 3. Dislocation or subluxation following trauma 4. Repeated micro trauma such as AGMR 5. Following surgical procedures
43
Is there any test to definitively define hip hyper mobility?
No
44
Hip hyper mobility symptoms
Pain in groin, butt or thigh, sometimes “c-shaped”, hard to palpate Apprehension/giving way
45
Non operative hip hyper mobility tx
No reports in literature exist but anecdotal evidence shows significant number of patients improve without surgery
46
What is sign of the buttock
Test to identify serious pathology: Do SLR and then check hip motion with knee bent, if no difference then it is positive for serious pathology (should get more hip flex with knee bent)
47
ACL and PCL when knee flexed
Knee flexed to 90 ACL: prevents tibial anterior translation PCL: prevents posterior tibial translation
48
Which direction or orientation do the ACL and PCL take with knee flexion
PCL goes vertical, ACL more horizontal
49
What does extension do to ACL and PCL
Stretches them
50
Arcuate ligament connect
Runs in 2 bands from styloid of fibula
51
What lig consists of fibers from semembranosis tendon
Oblique popliteal ligament
52
Which muscles assist LCL and MCL
LCL: IT band MCL: sartorius, gracilis, semitendinosis
53
Axial rotation of knee only occurs when and why
Knee is flexed, when extended the cruciates and collaterals prevent it
54
Cruciates vs collateral winding and tibial motion
Cruciates are wounded counter clockwise and put on tension with tibial IR and slacked with tibial ER Collaterals wounded clockwise and put on tension with tibial ER and slacked with tibial IR
55
Collaterals and cruciates prevent what tibial motion
Collaterals prevent tibial ER Cruciates prevent tibial IR
56
Patella is what kind of bone and its function
Seasmoid Increased efficiency of quads by shifting line of pull anteriorly by 1.5X
57
Patella glides which way with extension
Proximal about 8cm (more than double its size)
58
What keeps patella in groove with extension and why
Quad line of pulls drives patella laterally, at end ranges of extension once compressive forces reduced the patella does not go lateral due to lateral lip of femur
59
Patella should face
Anterior and slightly medial
60
Menisci purpose
Increase surface or contact area
61
3 surfaces of menisci
Superior: concave, contact femoral condyles Peripheral: joint capsule Inferior: medial and lat edges tibial condyles
62
Menesci shapes
Medial: semi lunar Lateral: almost complete circle
63
Menisci attachments
Medial meniscus: semi membranous, MCL, ACL Lateral meniscus: PCL, popliteus Both: deep fibers of capsule, intercondylar fossa, meniscopatellar fibers (Menisci connected by transverse lig)
64
PROM meniscus arthros
Follows same as femoral condyles Extension: both move anteriorly Flexion: both move posteriorly ER: lateral meniscus moves anterior, medial meniscus moves posterior IR: lateral meniscus moves posterior, medial meniscus moves anterior
65
Does medial or lateral meniscus move more
Lateral moves 2x as much (6vs12mm)
66
Meniscus AROM arthros
Flexion: medial pulled posteriorly by semembranosis and lateral pulled posteriorly by popliteus Extension: both pulled anterior or forward by quad
67
Meniscus AROM
Flexion: both pulled posteriorly, medial by semimembranosis and lateral by Poplitues Extension: both pulled forward or ant by quad
68
Fat pad shape and does what with flexion
Pyramid, spreads
69
Plica definition and incidence and sx
Left over septum, in 20-60% of adult knees Mimics maniacal sx
70
Knee bursae Total Flx Ext
5 Flx causes fluid to full gastric bursa Ext causes fluid to fill suprapatellar nurse
71
Screw home
Terminal phase extension causes small involuntary tibial ER Flx associated with 20 degrees involuntary IR
72
Open chain knee arthros
Flexion: tibia goes posterior on femur Extension: tibia goes ant on femur
73
Closed chained knee arthros
Flexion: femur rolls ant and glide post Ext: femur rolls post and glide ant
74
Tibial ER causes what to femoral condyles
Tibial ER: medial femoral condyle goes post and lateral goes ant
75
Knee resting position, closed packed and capsular
Rest 25 flx Closed max ext and max ER Capsular flx over ext
76
Knee rom
Flx 140 Ext 0-5 Er in flx 45 Ir in flx 30

Intro LE Hip and Knee (1 decks)

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