Lower extremities exam 3- hip Flashcards
1
Q
normal angle of inclination
A
125 deg
2
Q
coxa vara def
A
decreased angle of inclination
3
Q
coxa valga
A
increased angle of inclination
4
Q
how does the angle of inclination change throughout a human’s lifespan
A
start w/ high and decreases as weight bearing begins
5
Q
def angle of inclination
A
angular relationship of femoral head and femoral shaft of frontal plane (at hip joint_)
6
Q
angle of torsion def
A
angular relationship of femoral head and femoral shaft in the transverse plane= amount of twist on the femur
7
Q
angle of torsion normal degree
A
15-20
8
Q
angle of torsion anteversion
A
greater than 20
9
Q
angle of torsion retreoversion
A
less than 15
10
Q
hip/femoral anteversion degree
A
greater than 20
11
Q
what may femoral anteversion lead to
A
increase of Q angle, internal femoral rotation, squinting patella
12
Q
hip/femoral retroversion degrees
A
less than 15
13
Q
what does femoral retroversion lead to
A
femoral ER, laterally positioned patella, toe out gait
14
Q
bones of hip and pelvis
A
ilium, pubis, ischium, sacrum, coccyx, femur
15
Q
what 3 bones make up the pubis
A
superior rami, inferior rami, symphysis
16
Q
where is the ishium located anatomically
A
at the fold of the buttcheek where hamstrings insert
17
Q
innominate bone made up of what 3 hip structures
A
illium, ishium, pubis
18
Q
what makes up the socket of the hip joint
A
acetabulum and labrum
19
Q
what bone makes up the tail bone
A
coccyx
20
Q
what quad muscle crosses at the hip
A
rectus femoris
21
Q
what are the anterior muscles of the hip
A
rectus femoris, sartorius, illiopsoas
22
Q
medial muscles of hip
A
adductors, gracilis
23
Q
lateral muscles at the hip
A
gluteus medius, IT band, piriformis, quadratus femoris, obturator internus, obturator externus, gemellus superior, gemellus inferior
24
Q
posterior muscles at the hip
A
glutes and hamstrings
25
trochanteric bursa purpose
provides lubrication for where gluteus maximus passes over greater trochanter, IT band, hip abductors
26
gluteofemoral bursa def
separates gluteus maximus from origin of vastus lateralis
27
ischial bursa def
weight bearing structure when person is SEATED provides cushioning
28
iliopsoas bursa
LARGEST bursa in the body, covers AIIS, illiac fossa, lesser trochanter
29
muscles involved in hip flexion
illiacus, psoas, sartorius, rectus femoris, pectineus, adductor brevis, adductor longus, adductor magnus, gluteus medius, gluteus minimus
30
muscles involved with hip extension
adductor magnus, gluteus maximus, gluteus medius, biceps femoris, semimembranosus, semiteninosis
31
what can the clinican do to isolate the glute instead of allowing the hamstring to fire?
have patient lay prone and flex the knee to prevent hamstring from working
32
muscles involved with abduction
sartorius, tfl, piriformis, gluteus maximus, gluteus minimus, gemellus superior, gemellus inferior, obturator internus
33
muscles involved with adduction
pectineus, adductor brevis, adductor longus, adductor magnus, gracilis, gluteus maximus
34
muscles involved with internal rotation
tfl, gluteus medius, gluteus minimus, semimembranosis, semitendinosus
35
muscles involved with external rotation
psoas, illiacus, sartorius, adductor brevis, gluteus maximus, gluteus medius, piriformis, inferior gemellus, obturator internus, quadratus femoris
36
what's the artery at the hip
femoral artery
37
what does the femoral triangle include
sartorius, adductor longus, inguinal ligament
38
L1 DTR
39
L1 & L2 DTR which nerve
femoral nerve
40
what nerves are involved with the lumbar plexus
femoral, obturator, sacral
41
special test for angle of torsion set up
prone w/ knee flexed to 90, one hand palpates greater trochanter and uses a goniometer to measure.
42
special test for angle of torsion do
rotate femur until greater trochanter is maximally prominent, angle is measured by lower leg while knee remains flexed to 90
43
special test for angle of torsion + test
angle greater than 15 deg created after femur moved= femoral retroversion. angle greater than 20 deg created after femur moved= anteversion
44
q angle degrees m/f
18 deg F, 13 deg M
45
q angle def
relationship b/w ASIS, midpoint of patella and tibial tuberosity
46
leg length discrepancy special test *true
ASIS to medial malleolus
47
leg length discrepancy special test *apparent
umbilicus to medial malleolus
48
trendelenburg test set up
patient standing w/ weight evenly distributed on both feet, iliac crests or posterior superior iliac spines should be visible
49
trendelenburg test do
patient lift leg opposite of side being tested
50
+ trendelenburg test
pelvis lowers on non-weight bearing side
51
what does + trendelenburg test indicate
glute medius weakness
52
thomas test setup
patient supine, passively flex knee to chest and opposite leg rests on table
53
+ thomas test
involved leg rises off table OR involved knee moves into extension
54
+ thomas test indicates
tightness of iliopsoas OR rectus femoris
55
ely's test set up
patient prone, passively flex knee
56
ely's test +
hip on side flexes causing it to rise from the table
57
ely's test + indicates
tightness of rectus femoris
58
faber(patrick's) test set up
patient supine with involved foot crossed over opposite thigh, one hand on ASIS and other on medial flexed knee
59
+ patrick's test
reproduction of symptoms at hip
60
patrick's test indicative of
impingement at hip, labral tear,
61
what test should be done for the labrum of hip
faber (opposite) and anterior impingement (anterior), hip scouring (internal and external rotation), trendelenburg
62
piriformis test set up
patient laying on side, top leg positioned w/ hips at 60 deg flexion and knee flexion, stabilize pelvis and apply downward pressure at knee
63
piriformis test +=
pain
64
piriformis test + indicates
piriformis tightness or piriformis syndrome
65
anterior impingement test set up
patient supine, flex IR and adduct hip, rotate leg out
66
+ anterior impingement test
pain or reproduction of symptoms
67
anterior impingement test indicates
femoral acetabular impingement or labral tear
68
symptoms of anterior impingement test
pain, pop, click, lock, etc
69
hip scouring test set up
patient supine and fully flex hip and knee
70
hip scouring test perform
apply pressure downward along shaft of femur to compress joint surfaces, femur internally and externally rotated w/ hip in multiple angles of flexion
71
+ hip scouring test
pain, reproduction of symptoms
72
+ hip scouring test indicates
labral tear or defect in articular cartilage of femur or acetabulum
73
stress fracture test aka
fulcrum test
74
stress fracture test set up
patient seated at end of table, one hand under mid to distal thigh, other hand applies downward pressure on proximal knee
75
+ stress fracture test
pain
76
what does + stress fracture test indicate
femoral stress fracture
77
where may contusions of hip occur
illiac crest, greater trochanter, ischial tuberosity, coccyx
78
hip pointer aka
contusion of illiac crest
79
MOI hip pointer
direct trauma, fall
80
s/s hip pointer
pain, tender, pain w/ flexion and rotation, sneeze and cough may increase pain, crepitus upon palpation
81
tx hip pointer
protect w/ padding, RICE
82
coccyx contusion MOI
direct trauma, falling, sit hard
83
s/s coccyx contusion
pain w/ sitting, pt tender, swelling, discoloration
84
tx coccyx
f/o fracture, donught pillow to sit, RICE
85
hip strain MOI
overstretching, dynamic overload of muscle
86
s/s hip strain
pain, swelling, palpable defect
87
tx hip strain
crutches, appropriate ratio of stretch to strengthen
88
tendonitis is common where in hip
hip flexors
89
tendonitis MOI
overuse, repetitive hip flexion, run, kick, insidious onset
90
s/s tendonitis
pain, swell, tender
91
tx tendonitis
proper warm up, heat, RICE
92
trochanteric bursitis MOI
acute blow, overuse, irritation
93
risk factors trochanter bursitis
hip anteversion, increased Q angle, leg length discrepancy
94
s/s trochanter bursitis
pain of greater trochanter, pain radiates to butt, pain w/ stairs, discomfort sleeping on side, red, tender, snapping
95
tx trochanter bursitis
RICE, injection
96
when should hip be reduced to prevent neurological problems
less than 6 hours after injury
97
ischial bursitis MOI
acute blow, overuse, repeated shifting and moving while in seated position, rowing, prolonged sitting, biking
98
ischial bursitis s/s
pain at ischial tuberosity, tender, pain w/ flexion
99
tx ischial bursitis
RICE, activity modification
100
legg calve perthes disease def
lesion of femoral head that causes degeneration and flattening of femoral head
101
legg-calve perthes disease develops when in life
first decade (10 years)
102
is legg calve perthes more common in girls or boys
boys
103
MOI legg calve perthes
degenerative, single traumatic or multiple chronic events, disrupt blood supply, blood borne clotting factor, thyroid disease
104
s/s legg calve perthes
hip or groin pain, limp, decreased ROM, leg may appear shorter
105
what + test associated w/ legg calve perthes
+ trendelenburg test
106
tx legg calve perthes disease
confirm w/ x-ray, PT, improve ROM, bracing, surgery
107
what is most common hip disorder in adolescents
slipped capital femoral epiphysis
108
slipped capital femoral epiphysis affects boys or girls more
boys
109
unexplained hip and knee pain in kids could mean
slipped capital femoral epiphysis
110
what causes slipped capital femoral epiphysis
femoral head remains in acetabulum and femoral neck displaces anteriorly causing toeing out
111
what are 2 classifications of slipped capital femoral epiphysis
stable or unsable depending on if they are able to bear weight
112
MOI slipped capital femoral epiphysis
gradual onset or abrupt maneuver
113
risk factors slipped capital femoral epiphysis
overweight children w/ growth spurt
114
s/s slipped capital femoral epiphysis
pain that gets worse with activity
115
femoral stress fracture MOI
overuse due to rapid increase in frequency, intensity or duration
116
risk factors of femoral stress fracture
female, decreased calcium/vit D intake
117
s/s femoral stress fracture
deep aching pain, pain when rolling in bed, night pain, limits in extreme ROM
118
what special test is for femoral stress fracture
+ stress fracture test
119
tx femoral stress fracture
MRI, modify activity, progressive RTP
120
osteitis pubis def
inflammation of public symphysis
121
MOI osteitis pubis
overuse, run, kick
122
s/s osteitis pubis
groin pain, tender at symphysis, spasm of adductor, pain w/ resisted hip adduction, pain w/ trunk flexion
123
tx osteitis pubis
activity modification, nsaids
124
hip dislocation is usually anterior or posterior
posterior
125
MOI hip dislocation/subluxation
flexion and adduction w/ axial force, fall onto flexed knee w/ hip adducted, jump, stop or pivot, knee to dashboard
126
s/s hip dislocation
immediate intense pain, femur and lower legs in flexion, inability to WB
127
tx hip dislocation
immediate transport
128
avascular necrosis of femoral head def
blood floor interrupted or reduced
129
what is the major risk of avascular necrosis
bone death
130
what is most common complication after hip dislocation
avascular necrosis of femoral head
131
other causes of avascular necrosis
obesity, sickle cell, lupus, history of subluxations
132
femoral acetabular impingement common population
middle aged athletic individuals
133
def femoral acetabular impingement
abnormal stresses on surrounding soft tissue and bone resulting in labral tears, chondral degeneration, osteoarthritis
134
cam lesions def
at femoral head, result from abnormally shaped femoral head repeatedly contacting acetabulum and surrounding labrum
135
why might cam lesion develop
extensive sports participation during high growth period of adolescence
136
pincer lesions more common in what population
middle-aged, active females
137
pincer lesion may develop b/c
result when acetabulum is covering femoral head due to compression during flexion
138
femoral acetabular impingement MOI
gradual onset, repeated compressive forces from abnormally shaped head
139
risk factors femoral acetabular impingement
slipped capital femoral epiphysis, legg calve perthes
140
s/s femoral acetabular impingement
grain pain extends to lateral thigh, pain made worse by activity in flexion, antalgic gait, deep pain
141
what + tests for femoral acetabular impingement
FABER and anterior impingement
142
tx femoral acetabular impingement
avoidance of aggravating activities including excessive IR and adduction
143
labral tear MOI
acute, twisting, falling, mis-step, hyperextension, hyperabduction, dislocation, subluxation, repeated weight bearing
144
predisposing conditions of labral tear
slipped capital femoral epiphysis, FAI, capsular laxity
145
s/s labral tear
deep pain in anterior or medial hip, running distance limited
146
tx labral tear
attempt at conservative treatment, MRI, surgery if necessary
147
athletic pubalgia aka
sports hernia
148
sports hernia cause
unbalanced tension b/w upward pull of rectus abdominis and downward lateral pull of adductor muscle group
149
MOI athletic pubalgia
insidious, repetitive twisting, cutting, running, kicking
150
s/s athletic pubalgia
deep lower abdominal or groin pain, symptoms return after period of rest, pain w/ palpation of pubic ramus, adductors, pain w/ sit up, pain w/ cough or sneeze
151
tx athletic pubalgia
MRI, attempt at conservative treatment, surgery
152
MOI snapping hip syndrome
insidious, internal or external snapping
153
internal vs external snapping hip syndrome
iliopsoas contacting femoral head or other structure vs IT band catching greater trochanter
154
risk factors snapping hip syndrome
dancers in teens or 20s
155
s/s snapping hip syndrome
pain and snapping during running, jumping, cross stepping activities, pt has ability to recreate and palpate popping when hip moves from flexion to extension, bursitis
156
tx snapping hip syndrome
RICE, activity modification, NSAIDS
157
where does sciatic nerve usually pass through piriformis (under or over)
under piriformis
158
what % of population has piriformis problems
15%
159
where does sciatic nerve pass through to cause piriformis syndrome
through the piriformis muscle
160
who is piriformis syndrome more common in
women
161
piriformis syndrome MOI
congenital, overuse, repetitive kicking, running
162
s/s piriformis syndrome
pubic pain, spasm, tightness, tender, numb and tingle, burn, cough, sneeze causes pain
163
+ test for piriformis syndrome
piriformis test
164
tx piriformis syndrome
proper ratio of stretching and strengthening, steroid injection, surgical relase
165
hip osteoarthritis MOI
age, repetitive trauma, degernation of surfaces
166
s/s hip osteoarthritis
pain w/ weight bearing, referred pain to low back or knee
167
+ test for hip osteoarthritis
hip scour
168
tx hip osteoarthritis
activity modification, weight loss, NSAIDS, calcium, vit D supplements, hip replacement surgery
169
hip fracture MOI
car accident, high impact activity, direct trauma
170
s/s hip fracture
immediate pain, loss of function, deformity
