Lecture 7 - Hip Clinical Considerations & Knee Osteology Flashcards
What is greater trochanter pain syndrome?
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
What is tension stress with GTPS?
also comperssion (midstance and TFL)
What is the rx for GTPS?
injection, anti-inflam meds, cane and PT
- isometric abd, limit add, biomechanical assessments (LE alignment)
What can muscular dystrophy come along with?
GB, incomplete SCI, GTPS, hip arthritis/deg, poliomyelitis, LBP, disuse, atrophy
What is the trendelenburg sign?
- weak hip ‘falls’ into pelvic-on-femoral adduction, can be masked by trunk side lean
What muscle powers single leg bridging?
- 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
What happens during bilateral bridging exercises?
- less glut med activation than single leg
Where is pain with osteoarthritis of the hip?
- 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
What is a THA?
- 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
What is hip resurfacing?
- 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
What happens to the piriformis with the hip ext?
- line of force to ER the hip
What happens to the piriformis with hip flexion?
- IR the hip
What are the two main causes of hip impingement (FAI)?
- deformity of the ball at the top of the femur (cam impingement)
- a deformity of the socket (pincer)
What are key symptoms of impongement in the hip?
- pain in the hip or groin and a sensation of catching or sharpness during movement
- often consistent dull ache
- prolonged sitting or exercise bothersome
What happens with the acetabular labrum during injury?
- compressive, tensile, and/or shearing forces vs labrum
- poor healing
- rotational, repetitive, near end-range motions
- trauma
- often insidious
What is a common sign of a fx of the hip?
- shortening and ER of the leg
What should we know about usage of a cane and the forces?
counterclockwise forces (cane and hip abd) = clockwise forces (BW)
What does the can do if it is in the opposite hand?
reduces compressive forces
What does the cane also reduce? (aside from compressive forces)
- JRF by reducing activation of the hip abductors @ 36%
What is not idea with a compromised hip?
carry any ext loads
What are the components of the distal femur?
- 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)
What transfers the majority of load in the knee joint?
Tibia
What is special about the proximal end of the tibia?
larger, slightly concave
What is special about the lateral end of the tibia?
flat to slightly convex
What are the elements of the patella?
- 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
What are some alignment considerations of the femur?
slight medial slant due to angle of inclination
What is the normal knee angle in the frontal plane?
170-175 degrees in frontal plane – normal = genu valgum
What is genu valgum?
< 170 excessive genu valgum “knock-knee”
What is genu varum?
> 180 genu varum “bow-leg”
