LECTURE 5B HIP JOINT EXAM

Question 1

does age matter in the hip?

Answer 1

YES (dysplasia when young= issues forever)

Question 2

common hip pathologies for newborn

Answer 2

congenital dislocation of hip

Question 3

common hip pathologies for 2-8 year olds

Answer 3

AVN (legg Perthes)
*can get open growth plates if offloaded with brace

Question 4

common common hip pathologies of children

Answer 4

hemophilia
*blood clotting disorder
*blood can leak into hip joint, leading to effusion/inflammation

Question 5

common hip pathologies for 10-14 year olds

Answer 5

slipped epiphysis (SCFE) osteochondritis dissecans (OCD)

*obese young boys

Question 6

common hip pathologies for 14-25 year olds

Answer 6

stress fx, synovitis, FAI

Question 7

common hip pathologies of young adults

Answer 7

muscle lesion, bursitis, synovitis, FAI

Question 8

common hip pathologies of 45-60 year olds

Answer 8

OA, synovitis

Question 9

common hip pathologies of female 50+

Answer 9

Gluteus medius tendinopathy/tears

SUPER TRENDELENBURG

Question 10

common hip pathologies of older adults

Answer 10

stress fx, OA, fx & post-replacement

Question 11

common hip pathologies of 65+

Answer 11

stress fx, OA

Question 12

congenital hip dislocation causes limited

Answer 12

ABDUCTION

Question 13

If someone has a breech birth, what could happen?

Answer 13

congenital hip dislocation
BIRTH

Question 14

incidence for congenital hip dislocation

Answer 14

females more than males
Left more than right

Question 15

If someone comes in with a short limb, hip flexed, abduction…

Answer 15

congenital hip dislocation

Question 16

what two tests are for congenital hip dislocation?

Answer 16

galeazzi’s sign or ortolani’s sign
(displaces UP and LATERALLY (acetabulum delayed development)

Question 17

If someone is -___years old
male> female
gradual onset of hip ache/thigh/knee, what do they have?

Answer 17

age: 2-13 years
Legg-Calve-Perthes

Question 18

Legg Calve Perthes ROM deficits

Answer 18

Observation: short limb, higher greater trochanter, quad atrophy, adductor spasm
ROM: limited abd & ext
Gait: Antalgic after activity

Question 19

short limb, teenage males
usually obese
quad atrophy
adductor spasm
hip abduction, ER

Answer 19

SCFE

Question 20

What ROM is limited in SCFE?

Answer 20

limited in IR, abd, flex

Question 21

-Age: 30-50 y/o
-Incidence: Male > Female
-50% w/ sharp pain & 50% intermittent in extreme motion
-ROM: decreased
-Gait: limp

Answer 21

AVASCULAR NECROSIS

Question 22

intervention for avascular necrosis

Answer 22

protected WB
exercise
surgery if PT doesnt work

Question 23

Age: > 40 y/o
Incidence: Female > Male
Insidious onset, pain w/ weight bearing
Observation: often obese; joint crepitus; muscle atrophy of gluteal muscles
ROM: limited, capsular pattern
Gait: limp

Answer 23

DJD

Question 24

ALTMAN’S clinical criteria for hip OA

Answer 24

1. hip pain
2. IR less than 15
3. pain with IR
4. morning stiffness up to 60 min
5. older than 50 years old

Question 25

If someone 50+ shows up with hip pain, decreased IR, morning stiffness....

Answer 25

OA OR DEGENERATIVE

Question 26

Sutlive CPR for hip OA

Answer 26

1. pain with squat 2. Scour Test with adduction causes groin or lateral hip pain 3. Active hip flexion causes lateral pain 4. Active hip extension causing hip pain 5. Passive hip IR less than or equal to 25 degrees *3/5 positive =68% *4/5 positive =91%

Question 27

CPG for hip!

Answer 27

A: risk factors considered A: diagnosis/classification A: exam with outcome measures A: exam with activity limitation/participation restriction measures B: patient education, manual therapy C: Functional gait, balance training (important, but not first tx) E: diff dx

Question 28

hip OA ruling in...

Answer 28

Age and capsular pattern for ruling in

Question 29

Diff Dx tests for ruling OUT hip OA

Answer 29

scour test-labral FABER-labral Fitzgerald-labral FADIR-labral SI stress-SIJ femoral nerve stretch test-L2-3 radiculopathy

Question 30

acute care treatment for total hip arthroplasty

Answer 30

1. get up and moving PREVENT DVTs (HEP/gait/transfers) *home equipment recommendations PRECAUTIONS!!!!

Question 31

OP care for THA

Answer 31

-Progressive strengthening -Mobilization (gentle) into limited ranges (***extension) Soft tissue and neural mobility Advanced gait activities with/without AD BALANCE training

Question 32

most common muscle for myositis ossificans

Answer 32

quad muscle COMMON WITH TRAUMA (3wk post injury) *watch for decreasing ROM, increasing pain

Question 33

common mm strains

Answer 33

hamstrings rec fem (mid/upper 1/3) adductor longus

Question 34

post pelvis sx or pregnancy common injuries

Answer 34

osteitis pubis or symphysiolysis

Question 35

lateral hip, thigh or knee pain; snapping IT band over greater trochanter

Answer 35

ITB syndrome due to OVERUSE *ober's test

Question 36

Pain over greater trochanter; with resisted abduction Pain on palpation of greater trochanter *overuse OR direct trauma

Answer 36

trochanteric bursitis

Question 37

treatment for bursitis

Answer 37

Ice NSAIDs IT band stretching Protection from direct trauma Steroid injection (only 3x/year)

Question 38

treatment for ITB syndrome

Answer 38

Modification of activity Footwear Stretching & strengthening exercises NSAIDs

Question 39

Hx: direct trauma; contusion w/ hematoma 2-4 weeks prior S&S: pain on palpation & motions; ecchymosis Imaging: X-ray or US

Answer 39

myositis ossificans

Question 40

Hx: gradual onset, often obese & pregnant women S&S: pain or paresthesia of anterior or lateral groin & thigh Abnormal sensory examination over distribution of lateral femoral cutaneous nerve

Answer 40

Meralgia paresthesia

Question 41

treatment for myositis ossificans

Answer 41

ice, NSAIDs, stretching if PT fails-> SX

Question 42

treatment for meralgia paresthesia

Answer 42

Avoid external compression of nerve Nerve glides as appropriate

Question 43

Both pain when palpated, diffuse pain with LOAD is probably...(glute med tear or bursa?)

Answer 43

glute med tear

Question 44

SLIDE 20

Question 45

cam impingement

Answer 45

femoral neck/head has excess bone

Question 46

pincer impingement

Answer 46

acetabulum has excess bone