Lecture 7 - Hip Clinical Considerations & Knee Osteology

Question 1

What is greater trochanter pain syndrome?

Answer 1

ache, tender near GT
- can be a primary cause of lat hip pain
- common > 40 yo F
- weak hip abd/ gait deviation
- standing on one leg, climbing hills/stairs, prolonged walking

Question 2

What is tension stress with GTPS?

Answer 2

also comperssion (midstance and TFL)

Question 3

What is the rx for GTPS?

Answer 3

injection, anti-inflam meds, cane and PT
- isometric abd, limit add, biomechanical assessments (LE alignment)

Question 4

What can muscular dystrophy come along with?

Answer 4

GB, incomplete SCI, GTPS, hip arthritis/deg, poliomyelitis, LBP, disuse, atrophy

Question 5

What is the trendelenburg sign?

Answer 5

• weak hip ‘falls’ into pelvic-on-femoral adduction, can be masked by trunk side lean

Question 6

What muscle powers single leg bridging?

Answer 6

• middle and posterior fibers of the glut med of the working hip
• middle fibers offset the adduction of the adductor magnus
• anterior fibers of glut med and offsetting ER potentioal of glut max and ER of gravity

Question 7

What happens during bilateral bridging exercises?

Answer 7

• less glut med activation than single leg

Question 8

Where is pain with osteoarthritis of the hip?

Answer 8

• groin, thigh, buttocks, knee
• stapping and sharp OR dull ache
• hio often stiff, esp after getting out of bed, or sitting for a long time
• pain swelling, tenderness in the hip joint
• a sound or feeling of bone against bone
• inability to move the hip to perform routine activities

Question 9

What is a THA?

Answer 9

• cementless THA in a patient with osteoarthritis
• ceramic femoral head with a titanium stem and a polyethylene socket fixed into the pelvis by a screw
• can be cement or biologic fixation via bone growth into implanted device

Question 10

What is hip resurfacing?

Answer 10

• a surgeon trims damage from the natural bone ball at the top of the thighbone
• resurfaced with a smooth metal covering
• the surgeon also lines the natural bone socket of the hip with a metal lining or shell

Question 11

What happens to the piriformis with the hip ext?

Answer 11

• line of force to ER the hip

Question 12

What happens to the piriformis with hip flexion?

Answer 12

• IR the hip

Question 13

What are the two main causes of hip impingement (FAI)?

Answer 13

• deformity of the ball at the top of the femur (cam impingement)
• a deformity of the socket (pincer)

Question 14

What are key symptoms of impongement in the hip?

Answer 14

• pain in the hip or groin and a sensation of catching or sharpness during movement
• often consistent dull ache
• prolonged sitting or exercise bothersome

Question 15

What happens with the acetabular labrum during injury?

Answer 15

• compressive, tensile, and/or shearing forces vs labrum
• poor healing
• rotational, repetitive, near end-range motions
• trauma
• often insidious

Question 16

What is a common sign of a fx of the hip?

Answer 16

• shortening and ER of the leg

Question 17

What should we know about usage of a cane and the forces?

Answer 17

counterclockwise forces (cane and hip abd) = clockwise forces (BW)

Question 18

What does the can do if it is in the opposite hand?

Answer 18

reduces compressive forces

Question 19

What does the cane also reduce? (aside from compressive forces)

Answer 19

• JRF by reducing activation of the hip abductors @ 36%

Question 20

What is not idea with a compromised hip?

Answer 20

carry any ext loads

Question 21

What are the components of the distal femur?

Answer 21

• Lateral and medial condyles
• Lateral and medial epicondyles (ligament attachment sites)
• Intercondylar notch (passageway for cruciate ligs)
• Trochlear groove (condyles join) (PF joint – concave side to side, convex front to back)
• Lateral – more pronounced/ proximal and anterior/steeper slope and medial facets (slopes of groove)
• Lateral and medial grooves – in femoral cartilage (anterior edge of tibia aligned with these in full ext)

Question 22

What transfers the majority of load in the knee joint?

Answer 22

Tibia

Question 23

What is special about the proximal end of the tibia?

Answer 23

larger, slightly concave

Question 24

What is special about the lateral end of the tibia?

Answer 24

flat to slightly convex

Question 25

What are the elements of the patella?

Answer 25

• Largest sesamoid bone
• Base – curved, superior
• Apex – pointed – inferior, relaxed standing just proximal; to joint line
• Anterior surface - convex
• Posterior articular surface, 4-5mm articular cartilage, articulates with trochlear groove – PF joint
• Vertical ridge - rounded
• Lateral (larger matches lateral trochlear facet), medial, and “odd” facets

Question 26

What are some alignment considerations of the femur?

Answer 26

slight medial slant due to angle of inclination

Question 27

What is the normal knee angle in the frontal plane?

Answer 27

170-175 degrees in frontal plane – normal = genu valgum

Question 28

What is genu valgum?

Answer 28

< 170 excessive genu valgum “knock-knee”

Question 29

What is genu varum?

Answer 29

> 180 genu varum “bow-leg”