LE Flashcards
Muscle length testing procedures
-Hip flexors, extensors, and abductors
-Thomas test
-Straight leg raising (SLR) test
-Ober and modified Ober test
Hip ROM to perform normal ADLs
Hip flexion- 120
ABD- 20
ER- 20
muscles that perform hip flexion and extension
flexion: ilipsoas, rectus femoris, TFL, sartorius
extension :glute max, hamstrings
muscles that perform ER and IR
ER: deep rotators, (piriformis, obturator, gemllus), glute max, quadratus femoris.
IR: no prime movers but - glute med, min, TFL, adductors
muscles that perform hip abd and add
adductor magnus, longus, brevis, gracilis, pectineus
anterior pelvic tilt vs posterior pelvic tilt
coxa vara -
What are two common sources of referred pain to the hip
Nerve roots or tissues derived from spinal segments L1, L2, S1, S2, lumbar intervertebral and sacroiliac joints.
Is a decreased stance time on the painful side to avoid the stress of weight bearing.
antalgic gait pattern
common participation restrictions and activity limitations in patients with hip disorders
Continued pain with weight bearing activities such as walking, pain may interfere with work or routine household activities, difficulty rising from a chair, climbing stairs, squatting, ADLs (bathing, toileting, dressing, etc.)
What are some signs and symptoms of osteoarthritis in the hip?
Mild to moderate pain level, decreased knee extension strength and decreased hip ROM.
-Squatting aggravates pain, active hip flexion causes lateral hip pain, the scour test with adduction causes lateral hip or groin pain, active hip extension causes pain.
What are the weight-bearing and ROM restrictions after an acetabular labral tear?
After resection and debridement: partial weight bearing for up to 2 weeks post op. After repair: partial weight bearing for up to 4 weeks postop. Gradual progression of weight- bearing based on joint irritability and pain. Use of ambulation aids for joint protection.
ROM: AAROM on first postop day, gradually progressing to AROM, stationary cycling with seat raised (to limit hip flexion) within first postop week, limit hip flexion to 80-90, full ROM (abd and ER) 2 weeks postop, AROM by 2 weeks and progressing with low-load resistance, progressive weight bearing and balance exercises incorporating weight bearing restrictions.
patient-related risk factors for joint dislocation after a THA?
Age over 80 to 85 years, THA for femoral neck fracture, medical diagnosis: higher risk in patients with inflammatory arthritis (mostly RA), poor quality soft tissue from chronic inflammatory disease, history of prior hip surgery, preoperative and postoperative muscle weakness and contractures, cognitive dysfunction, dementia.
When is a minimally invasive THA indicated? What are the post-operative advantages over a traditional THA procedure?
Length of incision less than 10 cm, depending on location. Muscles and tendons left intact. Single incision or two incision (4-5 cm) surgical approach. Posterior approach, lateral approach. (Box 20.3). Benefits: less blood loss, less postop pain, shorter hospital stay.
What are the weight-bearing restrictions after a THA and for long must they be maintained? And why must they be maintained?
- Posterior approach. To not bend hip more than 90 degrees, not rotate hip inward, not bring the legs in across beyond neutral, TDWB.
- Anterior/anterolateral and direct lateral approach. no hip adduction past neutral, no hip internal rotation past neutral, and no hip flexion >90. Adhere to these principles for a minimum of 12 weeks until soft tissue stabilization has occurred; however, hip flexion may increase >90 at 6 weeks. Certain surgical approaches may have special precautions, surgeons will inform patient and therapist.
What activities are not allowed after a THA?
do not cross legs, avoid sitting in low seat to avoid too much flexion, avoid bending trunk over the legs when rising from sitting down in a chair or when dressing and underdressing, do not rotate to the involve side, avoid hip add past neutral, etc. pg 758
What is an ORIF of the hip? What is the weight-bearing restrictions and how long must they be maintained?
Open reduction and Internal Fixation is a surgical intervention that by means of open reduction followed by stabilization with internal fixation used for fractures such as displaced or nondisplaced intracapsular femoral neck fractures, dislocations of head of the femur, stable or unstable intertrochanteric fractures, subtrochanteric fractures, etc. WB is determined by surgeon, factors influence the pts age, bone quality, type of fixation. Recommendations range from non-weight bearing, touch down WB, WBAT.
What patient population suffers from intracapsular fractures that result in hemiarthroplasty?
Trauma is the most common cause of femoral neck fractures. Being over the age of 50 or having a medical condition that weakens your bones, such as osteoporosis, increases your risk of a fracture in the femoral neck. Having bone cancer is also a risk factor.
What is piriformis syndrome? Is it the same as “sciatica” - why or why not? What interventions are appropriate for this condition?
Piriformis syndrome causes pain or numbness in your butt, hip, or upper leg. It occurs when the piriformis muscle presses on the sciatic nerve. The condition may be caused by injury, swelling, muscle spasms or scar tissue in the piriformis. sciatica results from spinal dysfunction such as a herniated disc or spinal stenosis. Piriformis syndrome, on the other hand, occurs when the piriformis muscle, located deep in the buttock, compresses the sciatic nerve. Interventions for it will be targeted strengthening exercises to the piriformis muscle, manual therapy, and movement reeducation.
What is trochanteric bursitis? What is the muscle that would benefit from strengthening in patients with this condition?
Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the part of the hip called the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. Straight leg raises to improve strength of your gluteus Medius, strengthening it can be an effective strategy for treatment.
What 3 ligaments attach to the medial meniscus? What one ligament is attached to the lateral meniscus? What implications does this have related to injury of the knee?
The medial meniscus is attached to the medial collateral, anterior cruciate and posterior cruciate ligaments. The lateral meniscus is attached to the anterior and posterior cruciate ligaments. Since they have too many attachments, the medial meniscus has a greater chance of sustaining a tear when there is trauma to the knee than the lateral meniscus, but they are both at writs because of the ligaments.
factors that impact patellar tracking
Increased Q angle: there may be increased force between the lateral patellar facet and lateral femoral condyle when the knee flexes during weight-bearing. Muscle and fascial tightness: a tight IT band and lateral retinaculum prevent medial translation of the patella. Hip muscle weakness: hip abductor and external rotator weakness may result in femur adduction and knee valgus and contribute to increased medial rotation of the femur.
At what range of motion is the torque of the quadriceps muscle the highest? How does this affect how you might design a resistance program to strengthen the quads?
The peak extension torque occurs between 70 and 50 degrees. It would affect in a way that we should be aware that the peak torque occurs later in the range of motion with increasing angular velocity, especially when testing weak muscle groups. In high angular velocities this may become a problem since the limb may pass the optimal joint position for muscular performance, and the recorded peak torque may not represent the subject’s maximal torque capacity.
common sources of referred pain in the knee.
Nerve roots and tissues derived from spinal segments L3 refer to the anterior aspect, and those from S1 and S2 refer to the posterior aspect of the knee.
Describe the muscle activity in the control of the knee during the gait cycle
During gait cycle, the knee goes through a range of 60 degrees, some medial rotation of the femur as the knee extends at initial contact and just before heel-off.
Stability of an efficient gait is controlled by the quadriceps, hamstrings, soleus, and gastrocnemius. The quadriceps control the amount of the knee flexion, hamstrings control knee extension, soleus is the limits the amount of knee flexion during preswings by controlling the tibia over the foot and the gastrocnemius also helps supporting the knee extension at the end of loading response. Pg 801.
extensor lag. How does it impact exercise prescription for the knee?
An extensor lag may develop if there is prolonged joint effusion, stiffness, and pain in which the active range of knee extension is less than the passive range available. Close kinetic chain exercises, and there will probably be weakness and instability, also balance exercise is also a good idea.
Common fibular (peroneal nerve). Why is it subject to injury? What is the functional result of injury?
Causes of damage to the peroneal nerve include the following: Trauma or injury to the knee, fracture of the fibula, use of a tight plaster cast or other long-term constriction of the lower leg. Injuries to the peroneal nerve can cause numbness, tingling, pain, weakness, and a gait problem called foot drop.
Which of the following TKA’s is more likely to be WBAT? Cemented, cementless? With
With cemented fixation, WBAT using crutches or walker is usually permitted right after surgery. With biological/uncemented vary from only TDWB for 4-8 weeks while using crutches or a walker to WBAT within a few days after surgery
TKA – Provide at least two Interventions at each stage of healing.
Maximum protection: pain modulation modalities and compression wrap to control effusion. Moderate protection phase: patellar immobilization, LE stretching program. Minimum protection: continue as previous phase, advance as appropriate, progression of balance and advances functional activities. Table 21.2, pg814.
What is the most common mechanism of ACL injury?
Disabling instability if the knee due caused by complete or partial acute ACL tear or chronic ALC laxity, frequent episodes of the knee giving way during routine ADLs as the results of significantly impaired dynamic knee stability despite a course of nonoperative management. A positive pivot shift test indicating rotational instability, Injury of the MCL at the time of ACL injury to prevent lax healing of the MCL. Increased risk of reinjury because of participation in high-demand work, sports, etc.
What is the terrible triad? How does rehab after an injury and repair to the terrible triad differ than from an ACL injury and repair?
O’Donoghue triad, a knee injury involving multiple ligaments and cartilage within the knee. The medial collateral ligament (MCL), anterior cruciate ligament (ACL), posterior cruciate (PCL), and medial and/or lateral meniscus (cartilage) all sustain damage
What exercises should a patient do in each of the 3 stages of recovery after ACL reconstruction?
Maintain full range of motion equal to your other leg with minimal to no swelling or pain. Being able to bend your reconstructed knee the same amount as the non-surgical knee is critical. Continue to increase the strength of your surgical leg to 70 to 75 percent of the strength of your non-surgical leg by increasing exercise resistance. Continue to improve single-leg balance (which is harder than it sounds) and improve motor control. Single and double leg hopping in place with proper mechanics and no pain. Add sports-specific activities as tolerated.
