Mod 2: Hip/Knee/Sports Med Flashcards by Alyssa Donley

fxn of iliofemoral ligament:
“ ischiofemoral ligament
“ pubofemoral ligament
(what do they restrict)

restrict ext/ER/add
restrict IR/add (on posterior side)
restrict ext/ABd

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3 nerves of the hip

femoral
obturator
sciatic (becomes tibial & common fibular)

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hip angle of inclination: outward angle that’s greater than normal (limb is longer)

coxa valga

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hip angle of inclination: inward angle that’s less than normal (limb is shorter)

coxa vara

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angle of inclination of hip is in what plane?

frontal plane (norm 125*)

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angle of torsion of hip is in what plane?

transverse plane
(relationship between head & shaft of femur)

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femoral head forward or internal femoral torsion

anteversion/toe in
>35*

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femoral head back or external femoral torsion

retroversion/toe out
>45*

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HIp special test: for femoral anteversion/retroversion

Craig test (find parallel greater trochanter)

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HIp special test: iliopsoas contracture/labral tear, if leg doesn’t touch table supine

Thomas/Modified Thomas

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Hip special test: flexibility of rectus femoris in prone (pos if hip flex or pelvic anterior rotation early)

Ely’s Test

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Hip special test: flexibility of ITB/TFL (pos if doesn’t touch table in Add)

Ober Test

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Hip special test: flexibility of hamstrings (pos if 20* or > from straight knee)

90/90 SLR Test

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Hip special test: weak gluteus medius & hip drop of unsupported side

Trendelenburg

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Hip special test: OA/labral pathology (use ABD/ER & ADD/IR)

Scour test

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Hip special test: hamstring tightness (pos w/ extension of trunk when extending knee in seated)

Tripod sign

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Hip special test: piriformis tightness/ compression of sciatic nerve

Piriformis test

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Hip special test: iliopsoas, SI, hip or lumbar pathology

FABER (Figure 4/Patrick’s Test)

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which glide to improve flexion & IR?
which other glide to improve flexion?

posterior glide
inferior glide

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which glide to improve extension & ER?

anterior glide

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limitation in passive hip ext d/t lack of extensibility of mm or ligaments of hip
-adapted shortened position

hip flexion contracture

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pain w/ passive stretching or active contraction
d/t trauma, overuse, overstretch, forceful contraction

MM strain

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sharp to dull pain over region
-ex: trochanteric, iliopectineal, ischial

Hip Bursitis

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sharp s/s w/ activities that stress the tendon
-dull ache at rest

hip tendinopathy

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early & excessive contact of femoral head & acetabular rim (pincer, cam, combo) -anterior hip/groin pain from structural abnormalities or labral tear

femoral acetabular impingement (FAI)

type of FAI: acetabular over coverage of femoral head that damages labrum & delaminates cartilage

Pincer

type of FAI: deformity of femoral head which causes shear forces on articular surfaces during flexion and cartilage delamination

Cam

S/S: – Pain in the groin and hip – Locking, stiffness of hip joint – Limited range of motion – Often after a forceful injury – Otherwise long term faulty mechanics cause wearing away at the joint surface – Very similar to FAI

Labral Tear

focal loss of cartilage s/s: jt pain/stiffness, related to activity, gradual onset, limited mobility, butt/groin/thigh/knee pain

Hip Osteoarthritis

explain difference between total & hemi THA

total: replaces femoral head & acetabulum hemi: replace femoral head

WB status of cemented THA vs. non-cemented THA

cemented: WBAT (unless ST repair or ORIF) noncemented: TTWB or NWB

THA Posterolateral precautions

no ADD, IR, flexion > 90* & combo of all 3

THA Anterolateral Precautions

no ER, ext, ADD, flexion > 90* & combo of flex/ABD/ER

pelvic fracture: unstable vs. stable tx

unstable: surgery, NWB 6-8 wks, UE strength stable: pain as guide, WBAT w/ AD, CKC movement

3 areas of hip fracture

intertrochanteric subtrochanteric femoral neck

complications of hip fractures (2)

avascular necrosis DVT

flattening of femoral head at WB surface d/t AVN s/s: limp, pain in groin/hip/thigh, shortened LE, dragging leg, mm atrophy common in young boys

Legg-Calve-Perthes Disease

sudden/gradual anterior displacement of femoral neck from the capital femoral epiphysis -adolescents common

slipped capital femoral epiphysis

what type of gait? weak hip flexors tight hip flexors

forward trunk poor hip ext, forward trunk & inc. lordosis

what type of gait? weak hip extensors tight hip extensors

posterior trunk & heel strike ER leg in terminal stance

what type of gait? weak hip abductors

trunk shift to weak side or Trendelenburg

Which directions do knee ligaments resist? ACL PCL MCL LCL

resist anterior tib translation resist posterior tib translation resist valgus resist varus

which nerve innervates the knee? how does it split?

sciatic nerve becomes tibial & common fibular nerve

screw home mechanism bone orientation

tibia ER femur IR (OKC extension)

what factors may increase the lateral pull of the patella by quads in knee ext?

inc. Q angle tight lateral structures (ITB) weak medial structures (VMO) dec. hip strength causes valgus

what type of gait? weak quads

knee buckles during stance forward trunk @ heel strike

what type of gait? weak hams tight hams

dec. control in terminal swing; hyperext stance knee flexion in stance

2 Tests for ACL tear/instability

Anterior Drawer Test Lachman Test

Knee test for anterolateral instability if shift/clunk between 20-40* flexion (dec tibia on femur)

Lateral Pivot Shift Test

2 Tests for PCL tear/instability

Posterior Drawer Test Posterior Sag Sign

Knee special test: Valgus vs. Varus Stress Tests?

Valgus: MCL sprain/tear/unstable, PCL or posterior medial capsule Varus: LCL sprain/tear/unstable, PCL etc.

3 Tests for Meniscal lesions (pain, clicking over joint line)

Apley's Compression Test McMurray Test Thessaly Test

2 Tests for knee joint effusion

Brush Test Patellar Tap Test

Knee special test for chondromalacia/PFPS/DJD -pt perform quad set & pain/crunch/inhibition at distal quad/patella

Patellar Grind Test/Clarke's Sign

glide to increase flexion -at patellar jt -at tibiofemoral jt

distal glide of patella posterior glide of tibia on femur

glide to increase extension -at patellar jt -at tibiofemoral jt

proximal glide of patella anterior glide of tibia on femur (also posterior glide of femur on tibia)

Types/Locations of Tendinopathy of the Knee

Patellar (jumper's knee) quads hamstrings

pain over lateral femoral condyle @ 30* flex d/t overuse, repetitive trauma, or friction (poor biomechanics) s/s: sharp pain on outside of knee, pop/ snapping

ITB Friction Syndrome

MOI: noncontact, deceleration, planted foot, valgus stress, tibial IR, knee hyperext

ACL injuries

ACL grafts (autograft) come from which tendons? (2)

Hamstring patellar

exercises to avoid s/p ACL surgery

OKC exercises w/ ankle resistance especially

initial phase (0-2 wks) s/p ACL goals

achieve full knee extension quad control dec pain/swelling knee flexion ROM patellar mobs gait mechanics

MOI: forced posterior movement of tibia on femur; MVA; landing on flexed knee, hyperflexion w/ foot planted

PCL injury

MOI: valgus stress, deceleration, cut/pivot motions -feels unstable

MCL injury

MOI: trauma w/ knee flexed, rotation, shear compression -d/t degeneration or repetitive overuse s/s: pain, lock/catch, swell, buckle, functional impairment

Meniscal Injury

what does the unhappy triad damage? d/t valgus stress to knee

tearing of medial meniscus, ACL, MCL

MOI: trauma or planting w/ sudden change of direction s/s: audible pop, intense sharp pain, swell, difficult WB common in females

Knee Dislocation/Subluxationq

Tx options for articular cartilage defects

-debridement (smooth surfaces) -microfracture (small holes in subchondral bone to inc. blood supply) -autologous chondrocyte implantation (restore cartilage) -osteochondral autograft transfer (OAT)- relocates cartilage in the knee

s/s: pain around/behind patella, w/ stairs, w/ prolonged posture, @ end range flex/ext, crunch/pop w/ patellar movement

Patellofemoral Pain Syndrome

musculoskeletal weaknesses that contribute to PFPS -what is tight?

arch drop/pronation weak hip abductors & ER weak VMOs tight lateral structures (ITB, TFL, & hams)

loss of articular cartilage in medial/lateral compartment or patellar femoral

tibiofemoral Osteoarthritis

WB status for TKA: cemented vs noncemented/porous ingrowth

cemented: WBAT non: TTWB 6-8 wks

other knee related fx sites (3)

patellar supracondylar tibial plateau

traction apophysitis @ tibial tuberosity -related to microtrauma in adolescents s/s: pain/edema over tibial tuberosity; general tightness in hip/knee

Osgood-Schlatter Disease

traction apophysitis @ inferior pole of patella -similar to Osgood Schlatters

Sinding Larsen Johansson

cracks in articular cartilage & underlying subchondral bone d/t vascular deprivation, fragmented cartilage & bone s/s: pain, catching sensation

Juvenile Osteochondritis Dissecans

Areas of PT influence for athletic injury prevention

healthy nutrition education correct gear/fit time off/active rest/cross training proper technique warming up strength & flexibility training

Acute stage of healing for sports rehab

Immobilization/Protection

Subacute stage of healing for sports rehab

Rehabilitaiton

Chronic stage of healing for sports rehab

Function

POLICE for rehab

Protect, Optimal Loading, Ice, compression, elevation

when activity exceeds the body's ___ & ___ = net tissue damage

tolerance & capacity