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6 Orthopedics > L3 Hip Conditions > Flashcards

L3 Hip Conditions Flashcards

1
Q

Instability

A

excessive mobility that causes pain with or without the symptom of hip joint unsteadiness

can be dysplasia, subluxation, dislocation

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2
Q

Causes of instability

A

traumatic
atraumatic

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3
Q

Traumatic instability

A

MVA or other high energy event is the cause

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4
Q

Atraumatic Instability

A

repetitve axial loading and rotation in the presence of anatomic variation

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5
Q

RF for Atraumatic Instability

A

golfers, gymnastics, football, hockey, figure skating, ballet, adolescent athletes with mobility

acetabular dysplasia
soft tissue hypermobility
ligamentum teres tear

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6
Q

Instability S/S

A

pain in groin or anterior thigh
popping, locking, snapping
worsening pain with sitting, walking, running
limping, weakness, sensation of dead leg
unable to perform strenuous activities

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7
Q

Instability Imaging

A

Center edge angle can be altered
can develop labral hypertrophy to stabilize
can progress to labral tears and OA in adulthood

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8
Q

Center Edge angle

A

femoral head and acetabulum
<25° dysplasia
>39° over-coverage/pincer type FAI

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9
Q

PT management of instability

A
  1. Patient Ed
  2. Postural re-education
  3. Avoiding long lever hip flexion and high impact
  4. Strengthening of rotators, abductors, extensors, adductors
  5. Neuromuscular training/Proprioceptive

Should have PT for 8-12 weeks before considering surgery

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10
Q

Pericetabular Osteotomy

A

-for pts <40 and have failed with PT
-may delay or avoid need for THA in future
-high rate of complications
-NWB for 6-8 weeks
-return to school in 12 weeks, sport in 6-12 mo

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11
Q

Dysplasia

A

(the acetabulum is too shallow)

reduces joint stability, but joint can be unstable without having it
left untreated will lead to labral tears and OA

dysplasia + OA = need for THA

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12
Q

Femoracetabular Impingement

A

abnormal contact between femoral head/neck and acetabular margin from structural variations in proximal femur and/or acetabulum

may result in labral tears, chondral damage, OA

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13
Q

CAM structure

A

non-spherical shape of the femoral head, protrusion of the head-neck junction
thickening

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14
Q

PINCER structure

A

deeper acetabular socket, associated with acetabular retroversion
increased center edge angle

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15
Q

MIXED Structure

A

combination of cam and pincer, most common category of impingement

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16
Q

Epidemiology of FAI

A

10-15% of population
CAM = young, male athletes
Pincer = active middle aged women

most likely to be symptomatic with high speed, high impact rotational sports

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17
Q

FAI Clinical Exam

A

Hx = anterior groin pain, C sign, clicking, giving away
Obs = pelvic tilt
ROM = decreased flexion and IR, tight ilioposoas and joint
overall weakness

gait will show a slower cadence and limited hip extension. Squats will have limited motion

18
Q

FAI and muscle weakness

A

not a strong correlation between FAI and specific muscle weakness

global hip muscle weakness moderate predictor of whether FAI was symptomatic

19
Q

Does FAI mean automatic pain?

A

asymptomatic individuals is 29%
20-40s are most likely to have pain that is ONLY FAI. vs older will have OA w/FAI

self-efficacy and psychologic factors are more present in pts with pain and weakness

20
Q

PT Management for FAI

A

activity modifcation
patient ed
manual therapy
avoid end range stretching
progressive pain-free strengthening
neuro re-education
squat variations

21
Q

Labral Tear Epidemiology

A

most common in 4th decade, more women vs men
22-55% of patients with hip or groin pain
74% have no clear MOI

22
Q

Traumatic Labral Tear

A

acute, rapid twisting, hyperabduction, falling
compression from MVA

23
Q

Atraumatic Labral tear

A

combo of anatomic variants with repetitive forces

24
Q

RF for Labral tears

A

female
FAI
higher BMI
capsular laxity
hip dysplasia
illiopsoas overactivity
degeneration of surrounding tissues

25
Q

Subjective Labral Tear

A

sharp, deep, intermittent pain
anterior hip/groin pain
associated clicking or catching in hip
end of range pain with flexion or extension

26
Q

Labral Tear Exam

A

possible anterior or posterior pelvic tilt
flexed knee gait pattern, decreased stance time and stride length

special tests = none with high spin or snout

27
Q

Labral Tear and FABER/FADIR

A

FADIR will be + if its anterior
FABER will be + if its posterior

28
Q

PT Management for Labral Tear

A

sit in a higher chair
increase cadence to shorten stride
consider muscle imbalances
optimize mechanics
avoid loaded, rapid pivoting/twisting
manual therapy –> low grade joint mob for pain

29
Q

Medical Management Labral Tear

A

injection to relieve pain
surgery (successful if patient fails PT, low age, interest in surgery)

1/5 pts having surgery for labral will need another surgery

30
Q

Labral and surgery

A

most labral tears are asymptomatic; the decision to do surgery should be with caution and after conservative treatment has failed. Labral tears have a low chance of developing symptoms if asymptomatic

31
Q

Gluteal Tendinopathy

A

most prevalent of all LE tendinopathies
possible association with future development of OA
usually have concurrent LBP
takes between 3 wks to 1 year to heal

32
Q

Trochanteric Bursitis

A

true bursal inflammation may result from either chronic microtrauma, regional muscle dysfunction, overuse or acute injury

33
Q

Mechanisms and Pathophys of GT

A

chronic progressive tendon irritation from combination of compressive and tensile loading

compressive load increases naturally with increasing hip adduction; 40° of adduction has 106 N of force

34
Q

Epidemiology of GT

A

3 F vs 1 M
1 in 4 women over the age of 50 will be diganosed

35
Q

RF for GT

A

non-modifiable, female >40 y/o
abnormal biomechanics, plyometric overload, training error

36
Q

S/S of Gluteal Tendinopathy

A

lateral, posterolateral hip pain that can refer down lateral thigh
achy, dull or sharp
trendelenburg sign

aggravates: side-sleeping, WB activities, standing after prolonged sitting
Eases: bell curve of activity, mid range postures

palpation tenderness

37
Q

Imaging for GT

A
38
Q

PT Management GT

A

conservative treatment has high success rate over 6-12 weeks

relative rest
reduce intensity, duration, frequency of training
avoid sidelying sleeping, asymmetric standing, crossed legged sitting
minimize stretching
address any other deficits
isometrics
massage
taping

39
Q

Patient Ed for GT

A

patients often catastrophize, have depression, low self-efficacy, higher BMI

condition will be exacerbated with psychologic factors

40
Q

Medical Management for GT

A

injections of cortizone (only provided relief for about 3 mo)

surgery = irresponsive or grade 3-4 tears, does have good outcomes

6 Orthopedics (17 decks)

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