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6 Orthopedics > L4/5 Hip Conditions Cont. > Flashcards

L4/5 Hip Conditions Cont. Flashcards

1
Q

Non-arthritic joint problems

A

instability
dysplasia
femoro-acetabular impingement
labral tear
chondral lesion

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2
Q

Extra-articular soft tissue problems

A

gluteal tendinopathy
groin strains

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3
Q

Osteoarthritis Epidemiology

A

-one of the leading causes of disability and morbidity globally
-higher prevalence in US/Europe
-men are often more symptomatic for OA, receive more radiographs

Most common: Knee, Hip

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4
Q

RF for OA

A

Age (>50 most common cause of hip pain)
hip developmental disorders
previous injury to hip
genetics
high impact sports (not running)
BMI
acetabular retroversion

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5
Q

Natural History of OA

A

changes in shape, density, and biomechaanical capacity of bones, cartilage, periarticular fibrous tissue

muscle weakness, especially abductors
superior-lateral migration of femoral head
decreased AROM

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6
Q

OA Radiograph

A

Will show joint narrowing
Mod OA <2.5mm
Severe OA <1.5 mm

osteophytes
sclerosis

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7
Q

American College of Rheumatology clinical criteria for OA

A
  1. Hip pain, groin, anterior, or lateral thigh
  2. Either one of the following clusters:

a. hip IR <15°, Hip flexion ≤ 115°, Age > 50
b. hip IR ≤ 15°, pain with hip IR PROM, duration of morning stiffness ≤ 60 min, age >50

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8
Q

Outcome measures for OA

A

6 min walk
TUG
30 s sit to stand

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9
Q

PT and OA

A

Initial POC 6-12 weeks depending on level of function, pain, and patient compliance

PT ed: positions of comfort, weight management, activity mod, condition
Gait training
Balance training
Manual therapy
Flexibility
Strengthening

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10
Q

Medical Management of OA

A

Bracing is not advices
NSAID injection may give short term pain relief
not enough evidence to support supplements
Visco-supplementation = not covered by insurance

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11
Q

Indications for THA

A

incapacity pain
limited motion that isn’t improving
impaired weight bearing and gait
radiographic features
failed conservative care

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12
Q

Posterolateral THA

A

more proven long-term outcomes
little blood loss
better visualization
shorter learning curve for surgeon
higher risk of dislocation
more muscle damage

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13
Q

Anterior Approach THA

A

less risk of dislocation
minimal muscle damage
less post-operative pain
longer learning curve for surgeon
more operative blood loss
longer duration of surgery
typically faster rehab

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14
Q

Bipolar hemiarthroplasty

A

used to change the angle of the femur head in the acetabulum

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15
Q

Hip resurfacing

A

often used for athletes

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16
Q

Complications with THA

A

anesthesia reactions
leg length inequality
infection
DVT
falls
dislocation

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17
Q

Contraindications for posterolateral THA

A

no hip IR, adduction for 6 weeks
don’t cross legs while sitting, sleeping
don’t pivot towards that side while standing

18
Q

After THA

A

-in patient rehab might be needed depending on approach, surgeon’s perspective, and patient’s health
-home health care
-outpatient PT for 1-12 weeks

the first 4-6 weeks will have pain, limited function, ADs, precautions

19
Q

At 3 years s/p of THA

A

89% of patients were satisfied with the results

reasons why they weren’t satisfied:
higher function previously
expected higher function
didn’t have a better post op level of function

20
Q

Primary areas of groin pain origin

A

adductor
illiopsoas
inguinal
pubic
other
hip

21
Q

Groin Pain Epidemiology

A

mens soccer is very common
1/3 elite players will suffer groin pain

unreported injury may be much higher
hockey, rugby, baseball, football also have high incidence

22
Q

Patient History, groin pain

A

often on dominant side
gradual onset
past history, loading history
night pain

23
Q

Intrinsic risk factors for groin pain

A

previous groin injury, dec adduction strength, ROM
bony morphology

24
Q

Extrinsic factors for groin injury

A

71% non-contact
follow a quick change of direction
70% overuse, possibly due to load management

25
Q

Adductor related groin pain

A

S/S pain around the insertion of adductor longus tendon at the pubic bone. pain radiates distally along medial thigh

more likely if patient presents with pain on adductor stretching

26
Q

Illiopsoas related groin pain

A

pain the anterior part of proximal thigh more laterally located than adductor-related groin pain

pain reproduced with resisted hip flexion

27
Q

Inguinal related groin pain

A

pain in the inguinal region that worsens with activity
can occur with coughing, sneezing, sitting up in bed

pain reproduced with resisted abdominal muscle testing

28
Q

Pubic related groin pain

A

pain in region of symphysis joint and immediate adjacent bone

no particular resistance test, more likely if pain is reproduced by resisted abdominal and hip adductor testing

29
Q

Hip related groin pain

A

mechanical symptoms present, such as catching, locking, clicking, giving way

30
Q

FAI syndrome

A

motion or position related pain in hip/groin. pain may also be felt in the back, buttock, thigh. may describe clocking, catching, locking, stiffness, restricted ROM, giving way

restricted IR, evidence of labral or chrondral damage

31
Q

Snapping Hip Epidemiology

A

common in young athletes in teens and twenties
can be external, internal, internal intra-articular

32
Q

External Snapping Hip

A

ITB sliding over the greater trochanter
more common in runners

palpate greater trochanter as hip is actively flexed. applying pressure will stop snapping.

correlates with ober’s test

33
Q

Internal Snapping hip

A

Iliopsoas sliding over femoral head, iliopectinal ridge, or iliopsoas bursa
more common in dancers

snapping is reproduced passively
tender to palation of iliopsoas tendon w/resisted hip flex
moving hip from flex/Er to ext/IR positions reproduces snapping

34
Q

Internal intra-articular snapping hip

A

labral tear, synovial chondromatosis

35
Q

Potential Interventions for snapping hip

A

-iliopsoas stretches, progressive strengthening
-long axis hip distraction, post mob for pain
-lumbar stabilization/anti-lordotic exercises
-limiting passe developpe and grand battement
-success of tx was determined as negative illioposas test and return to activities
-all patients respond to conservative tx

36
Q

In young and middle-aged adults presenting with anterior hip pain, where serious pathology has been ruled out, they most likely have

A
  1. FAI
  2. Dysplasia, instability
  3. Other labral/chondral disorders

imaging shouldn’t be used in isolation
FADIR helps to rule out hip pathology

37
Q

Level A interventions for OA

A

flexibility, strengthening, endurance, joint mob, manual therapy
Dosage: 1 to 5 times a week, 6 to 12 weeks

38
Q

Level B Intervention for hip OA

A

patient education
addressing WB activity modifcations
provide exercises to support weight reduction
discuss unloading the arthritic joint

39
Q

Level C Interventions for hip OA

A

balance, functional, gait training
proper use of ADs
individualized exercise prescription based on values, needs, activities

40
Q

OA and Manual Therapy

A

proven to be helpful for pain, ROM, and function in both short and long term

includes distraction, mobilization

dosage: 10 min or more, minimum bouts of 30 s
Duration: 1-3x week for 2-6 weeks

progress to include stretching, strengthening, etc

41
Q

PTs role for prognosis

A

identify descrepancies between level of function by the individual, the capacity of the individual, their current abilities

6 Orthopedics (17 decks)

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