MS: Hip Flashcards
What is a femoral neck fracture?
This type of break occurs in the femur about 1 or 2 inches from where the head of the bone meets the socket.
Increased AVN Treated with hemi arthroplasty: Only replacing femoral part. 3% sport injury SX: Groin pain Return to sport:3-6 months
What is an Ischial Bursitis?
Occurs with pressure on Ischial Tuberosity: sitting, sedentary lifestyle, can be direct trauma or a hamstring injury.
What is an Iliopectineal Bursitis?
Repetitive use of Iliopsoas: running, swimming
What is a Trochanteric bursitis?
Overuse along greater trochanter. Running, standing, climbing stiars, falling on lateral hip, LLD, laying on side.
Avoid activities that aggervate.
Strengthen Glute med
Pain with palpation
What is a strain?
Contractile lesion.
Most commonly strained mm: hamstrings, dductor, iliopsoas, rectus femoris
Mainly in athleted
Overuse
Normal angle of inclination in adults
120 degrees
Coxa Valga
> 130 degrees
Longer leg
Compensates with Genu Varus
Angle will add length
Coxa Vara
<110
Shorter leg
Compensates with genu valgus
Management for Coxa vara/valga
Surgery to normalize angle: Osteotomy
- take out bone to re- align angle
Normal femoral torsion
15 degrees anterior to frontal plane
Retroversion is under 15
anteversion is over 15
Consequences of excess anteversion or retroversion?
Children with anteversion= in-toeing (pigeon toe)
Children with retroversion= Duck walk
Can grow out of it
Structural/functional compensations of anteversion/retroversion?
Anteversion: IR
Retroversion: ER, overpronation
Indications of a THA?
Severe hip pain which limit ability to preform ADLs Major functional loss Instability of hip AVN/ Osteomylitis Failed previous surgery
Posterior Lateral incision
Most common
Split glute max and short ER muscles are released
Highest risk of dislocation
Precautions of Posterior-Lateral incision?
Do not: Cross legs, sleep on side, bend forward, squat
No IR/ADD/flexion past 90
Antero-lateral incision
TFL + GLute med: some portion og hip abductor is released from greater trochanter.
Less chance of dislocation
More gait distribution
Precautions of Antero-lateral incision?
Do not: Hip ext, ER, ADD, flex greater than 90
No AROM of hip abd for 6 weeks
Anterior approach
Becoming more popular
Does not split muscles, moves muscles apart (goes between muscle groups)
heals better and less restrictions
Will not do this if pt has high BMI and tissue over front or if it is a revision
Precautions of anterior approach
No extension and excessive ER
Avoid bridges an prone lying due to lordosis stress
Cemented THA vs Porous THA
Cemented: WBAT after surgery, most common.
Pourous: (biological) NWB for a span after surgery
What is trochanteric osteotomy?
Sometimes preformed in conjunction to THA.
Cut trochanter to access acetabulum
No AROM hip ABD for 6-8 weeks, only PROM.
Hip resurfacing
Younger patients to preserve more bone
femoral head and acetabulum covered in metal
postero-lateral approach
less risk of dislocation, less restrictions, easy THA conversion
Entrapment syndrome (Piriformis syndrome)
Compression of sciatic nerve by shortened piriformis
Beneath or through shortened muscle
Sharp/shooting pain down back of leg
Pain increased with walking, decreases with sitting
Pain replicated with FLEX,IR,ADD (FAIR) Test
Patient may stand with LE in hip ER (takes tension off piriformis)
FIndings of patients with piriformis syndrome?
Decreased hip IR an flex ROM
tight hamstrings
positive piriformis test
What would we do with a pt who has piriformis syndrome?
Stretch tight muscles, we want IR and flexion.
Figure 4 stretch
Correct standing and walking alignment, neutral femur (less ER)
Lengthen muscles with heat then use stretch window
Re-train muscle balance of ABD and ADD
ex) pillow between knees and do sit to stands
Labral Tears
Arthroscopic surgery labrum is pimarily avascular Labrum holds ball & socet SX: groin pain, anterior hip pain, clicking, pain with passive hip flex/add/IR, minimal to no restrictions with ROM C sign for pain spot
