Lecture 7: hip and knee Flashcards
what is greater trochanter syndrome
primary cause lateral hip pain
common in females > 40
symptoms of GTPS
ache/tender near greater trochanter
weak hip abd/gait deviations
pain with SLS, stairs, prolonged walking
type of stress that occurs with GTPS
tension and compression stress
occurs at midstance with TFL
Rx for GTPS
injections
anti inflammatory meds
cane
PT (isometric ABD, limit ADD, and improve LE alignment)
common conditions that cause weakness of hip abductors
Muscular dystrophy
guillian barre
incomplete spinal cord injury
GTPS
hip arthritis/deg
poliomyelitis
LBP
atrophy
what can abductor weakness lead to
postural instability
falls
patella femoral pain
LBP
ankle pain
knee instability
where might pain occur with osteoarthritis of the hip; describe this pain
groin
thigh
butt
knee
can be sharp or dull
usually occurs with stiffness
symptoms of osteoarthritis of hip
sharp or dull pain
stiffness
pain/swelling/tenderness of hip
sound/feeling of “crunching” (bone against bone)
inability to move hip with routine activities
what occurs (pathogenesis) with osteoarthritis of the hip
loss of joint space
deterioration of cartilage
thickened capsule
sclerotic subchondral bone
osteophytes
ultimately causes joint incongruity
describe a THA (what cementless might consist of, different fixation options, and what could cause damage)
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
what is a hip resurfacing
surgeon trims damage from femoral head and then resurfaces with smooth metal covering
natural socket is also lined with metal lining or shell
most common THA approaches
posterior approach (PA)
direct lateral approach (DLA)
direct anterior approach (DAA)
positive effects of coxa vara
increased moment arm of hip abductor force
alignment may improve stability
negative effects of coxa vara
increased bending moment arm that can increase shear force across femoral neck
decreased functional length of hip abductor force
positive effects of coxa valga
decreased bending moment arm that decreases shear force on femoral neck
increased functional length of hip abductor muscles
negative effects of coxa valga
decreased moment arm for hip abductor force
alignment may favor joint dislocations
what are the changing actions of piriformis
with hip extension = external rotator; line of pull posterior to vertical axis of rotation
with hip flexion = internal rotator;
what may cause pain with a cam impingement
may occur with activities like riding bike or tying shoes
IR and flexion maximize this impingement
what action causes the most pain with pincer impingement
flexion
pathomechanics of impingement at the hip
extra bone repeatedly rubs against labrum/cartilage
eventually bone rubs against bone
tears of labrum can also fold into joint space and get pinched
describe what can cause a labral injury
rotational, repetitive, end range motions
trauma like dislocation, deep squats, strenuous pull/lift
what is developmental dysplasia of the hip
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
what might you see in an older individual who had developmental dysplasia as a child
degenerative arthritis
laterally displaced and flattened femoral head
inadequate coverage provided by acetabulum
common hip fx location in elderly
proximal femur
most common causes for hip fx
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
risk factors for hip fx
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
complications of hip fx
reduced independence
shortened life
immobility
blood clots
bedsores
UTI
pneumonia
muscle mass decrease
death
clinical presentation of hip fx
shortening and ER of leg due to muscle spasm in adductors
benefits of use of a cane
reduced compressive forces when held in opposite hand
reduced JRF by reducing activation of hip abductors by 36%
intercondylar notch is the passage way for what
cruciate ligaments
describe the trochlear groove
concave side to side
convex front to back
what attaches to the fibular head
lateral collateral ligament and biceps femoris
what are the alignment considerations of the femur
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
