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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
Q

Hip OA incidence, symptoms, and gold standard diagnosis

A

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

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26
Q

CPRs for hip OA

A
  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
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27
Q

Treatment of hip OA

A

Manual, exercise, aerobic

Manual has best outcomes and should be first choice

Manual= manipulation and stretching

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28
Q

FAI of hip definition and 2 types

A

Overcoverage of femoral head from acetabulum

Pincer and Cam

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29
Q

Pincer FAI definition

A

Acetabulum covers too much of the femoral head

No potential for any real damage here

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30
Q

Cam FAI definition and prognosis

A

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

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31
Q

With a cam, what 2 motions cause increased compression and shear into articular cartilage of hip

A

Flexion and IR

32
Q

Does articular cartilage become damaged from shear or compression?

A

Shear

33
Q

Hip joint pain anteriorly is most correlated with

A

Articular cartilage damage

34
Q

Those with CAMs will like what motion

A

ER

35
Q

Cam TX considerations

A

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
Q

Lig teres

Strong as
Tears

A

ACL
Prevent excess motions when playing sports
Tears will created excess flex and IR in patients

37
Q

Lig teres test

A

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
Q

Labral tears

Found where in hip
Sx

A

Anterior quadrant
Pain in anterior hip, groin with clicking, popping and giving way

39
Q

Labral tears diagnosis

A

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
Q

Most consistent exam finding for labral tears

A

Positive scour test

41
Q

Hip joint hyper mobility and young

A

Now deemed a potential cause of pain and disability in young population

42
Q

Hip joint hyper mobility categories

A
  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
Q

Is there any test to definitively define hip hyper mobility?

A

No

44
Q

Hip hyper mobility symptoms

A

Pain in groin, butt or thigh, sometimes “c-shaped”, hard to palpate

Apprehension/giving way

45
Q

Non operative hip hyper mobility tx

A

No reports in literature exist but anecdotal evidence shows significant number of patients improve without surgery

46
Q

What is sign of the buttock

A

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
Q

ACL and PCL when knee flexed

A

Knee flexed to 90

ACL: prevents tibial anterior translation
PCL: prevents posterior tibial translation

48
Q

Which direction or orientation do the ACL and PCL take with knee flexion

A

PCL goes vertical, ACL more horizontal

49
Q

What does extension do to ACL and PCL

A

Stretches them

50
Q

Arcuate ligament connect

A

Runs in 2 bands from styloid of fibula

51
Q

What lig consists of fibers from semembranosis tendon

A

Oblique popliteal ligament

52
Q

Which muscles assist LCL and MCL

A

LCL: IT band
MCL: sartorius, gracilis, semitendinosis

53
Q

Axial rotation of knee only occurs when and why

A

Knee is flexed, when extended the cruciates and collaterals prevent it

54
Q

Cruciates vs collateral winding and tibial motion

A

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
Q

Collaterals and cruciates prevent what tibial motion

A

Collaterals prevent tibial ER
Cruciates prevent tibial IR

56
Q

Patella is what kind of bone and its function

A

Seasmoid

Increased efficiency of quads by shifting line of pull anteriorly by 1.5X

57
Q

Patella glides which way with extension

A

Proximal about 8cm (more than double its size)

58
Q

What keeps patella in groove with extension and why

A

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
Q

Patella should face

A

Anterior and slightly medial

60
Q

Menisci purpose

A

Increase surface or contact area

61
Q

3 surfaces of menisci

A

Superior: concave, contact femoral condyles
Peripheral: joint capsule
Inferior: medial and lat edges tibial condyles

62
Q

Menesci shapes

A

Medial: semi lunar
Lateral: almost complete circle

63
Q

Menisci attachments

A

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
Q

PROM meniscus arthros

A

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
Q

Does medial or lateral meniscus move more

A

Lateral moves 2x as much (6vs12mm)

66
Q

Meniscus AROM arthros

A

Flexion: medial pulled posteriorly by semembranosis and lateral pulled posteriorly by popliteus

Extension: both pulled anterior or forward by quad

67
Q

Meniscus AROM

A

Flexion: both pulled posteriorly, medial by semimembranosis and lateral by Poplitues

Extension: both pulled forward or ant by quad

68
Q

Fat pad shape and does what with flexion

A

Pyramid, spreads

69
Q

Plica definition and incidence and sx

A

Left over septum, in 20-60% of adult knees

Mimics maniacal sx

70
Q

Knee bursae
Total
Flx
Ext

A

5
Flx causes fluid to full gastric bursa
Ext causes fluid to fill suprapatellar nurse

71
Q

Screw home

A

Terminal phase extension causes small involuntary tibial ER

Flx associated with 20 degrees involuntary IR

72
Q

Open chain knee arthros

A

Flexion: tibia goes posterior on femur
Extension: tibia goes ant on femur

73
Q

Closed chained knee arthros

A

Flexion: femur rolls ant and glide post
Ext: femur rolls post and glide ant

74
Q

Tibial ER causes what to femoral condyles

A

Tibial ER: medial femoral condyle goes post and lateral goes ant

75
Q

Knee resting position, closed packed and capsular

A

Rest 25 flx
Closed max ext and max ER
Capsular flx over ext

76
Q

Knee rom

A

Flx 140
Ext 0-5
Er in flx 45
Ir in flx 30

Intro LE Hip and Knee (1 decks)

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