Lecture 7: hip and knee

Question 1

what is greater trochanter syndrome

Answer 1

primary cause lateral hip pain

common in females > 40

Question 2

symptoms of GTPS

Answer 2

ache/tender near greater trochanter

weak hip abd/gait deviations

pain with SLS, stairs, prolonged walking

Question 3

type of stress that occurs with GTPS

Answer 3

tension and compression stress

occurs at midstance with TFL

Question 4

Rx for GTPS

Answer 4

injections

anti inflammatory meds

cane

PT (isometric ABD, limit ADD, and improve LE alignment)

Question 5

common conditions that cause weakness of hip abductors

Answer 5

Muscular dystrophy
guillian barre
incomplete spinal cord injury
GTPS
hip arthritis/deg
poliomyelitis
LBP
atrophy

Question 6

what can abductor weakness lead to

Answer 6

postural instability
falls
patella femoral pain
LBP
ankle pain
knee instability

Question 7

where might pain occur with osteoarthritis of the hip; describe this pain

Answer 7

groin
thigh
butt
knee

can be sharp or dull

usually occurs with stiffness

Question 8

symptoms of osteoarthritis of hip

Answer 8

sharp or dull pain
stiffness
pain/swelling/tenderness of hip
sound/feeling of “crunching” (bone against bone)
inability to move hip with routine activities

Question 9

what occurs (pathogenesis) with osteoarthritis of the hip

Answer 9

loss of joint space

deterioration of cartilage

thickened capsule

sclerotic subchondral bone

osteophytes

ultimately causes joint incongruity

Question 10

describe a THA (what cementless might consist of, different fixation options, and what could cause damage)

Answer 10

cementless:
-ceramic femoral head
-titamium stem
-polyethylene socket (acetabulum)
-screw fixes socket to pelvis

THAs can be cement or biologic fixation via bone growth into implant

large torsional forces can cause loosening

Question 11

what is a hip resurfacing

Answer 11

surgeon trims damage from femoral head and then resurfaces with smooth metal covering

natural socket is also lined with metal lining or shell

Question 12

most common THA approaches

Answer 12

posterior approach (PA)

direct lateral approach (DLA)

direct anterior approach (DAA)

Question 13

positive effects of coxa vara

Answer 13

increased moment arm of hip abductor force

alignment may improve stability

Question 14

negative effects of coxa vara

Answer 14

increased bending moment arm that can increase shear force across femoral neck

decreased functional length of hip abductor force

Question 15

positive effects of coxa valga

Answer 15

decreased bending moment arm that decreases shear force on femoral neck

increased functional length of hip abductor muscles

Question 16

negative effects of coxa valga

Answer 16

decreased moment arm for hip abductor force

alignment may favor joint dislocations

Question 17

what are the changing actions of piriformis

Answer 17

with hip extension = external rotator; line of pull posterior to vertical axis of rotation

with hip flexion = internal rotator;

Question 18

what may cause pain with a cam impingement

Answer 18

may occur with activities like riding bike or tying shoes

IR and flexion maximize this impingement

Question 19

what action causes the most pain with pincer impingement

Answer 19

flexion

Question 20

pathomechanics of impingement at the hip

Answer 20

extra bone repeatedly rubs against labrum/cartilage

eventually bone rubs against bone

tears of labrum can also fold into joint space and get pinched

Question 21

describe what can cause a labral injury

Answer 21

rotational, repetitive, end range motions

trauma like dislocation, deep squats, strenuous pull/lift

Question 22

what is developmental dysplasia of the hip

Answer 22

found after birth or first few years of life

can can check for dislocated, subluxed, or poorly formed acetabulum

results in loss of normal input for development

can be caused from possible intrauterine positioning or abnormal neuromuscular development impact

Question 23

what might you see in an older individual who had developmental dysplasia as a child

Answer 23

degenerative arthritis

laterally displaced and flattened femoral head

inadequate coverage provided by acetabulum

Question 24

common hip fx location in elderly

Answer 24

proximal femur

Question 25

most common causes for hip fx

Answer 25

accidents like fall or MVA

stress fractures with athletes like long distance runners

minor injuries/falls with older individuals can cause fractures if they have osteoporosis

Question 26

risk factors for hip fx

Answer 26

age (decreased bone density/muscle mass)

females > males

osteoporosis

endocrine disorder (overactive thyroid)

intestinal disordes that reduce vit D/calcium

risk of falls associated with nervous system disorders

hypoglycemia

medications

lack of PA

tabacco/alcohol

Question 27

complications of hip fx

Answer 27

reduced independence
shortened life
immobility
blood clots
bedsores
UTI
pneumonia
muscle mass decrease
death

Question 28

clinical presentation of hip fx

Answer 28

shortening and ER of leg due to muscle spasm in adductors

Question 29

benefits of use of a cane

Answer 29

reduced compressive forces when held in opposite hand

reduced JRF by reducing activation of hip abductors by 36%

Question 30

intercondylar notch is the passage way for what

Answer 30

cruciate ligaments

Question 31

describe the trochlear groove

Answer 31

concave side to side

convex front to back

Question 32

what attaches to the fibular head

Answer 32

lateral collateral ligament and biceps femoris

Question 33

what are the alignment considerations of the femur

Answer 33

slight medial slant die to the angle of inclination

normal knee angle is 170-175 degrees in the frontal plane (genu valgum)

<170 = excessive genu valgum/knock kneed

> 180 genu varum/bow legged