Pathophysiology - LE Dysfunction Flashcards
test 2
T or F?
The hip joint is an articulation between the head of femur and the acetabulum of pelvis (also called innominate - made up of ilium, ischium, and pubis)
True
What is the most stable position of the hip joint?
Standing position: hip extension, slight abduction, slight IR
What has to happen to bend forward at the waist?
Head and upper trunk flex, pelvis shifts posteriorly, and once stable, begins to rotate forward, being controlled by glute max and hamstrings
What has to happen to return to uprights position form bent over?
Hip extensors rotate pelvis posteriorly and then back extensors work to bring spine upward
What is the frontal plane angle called between the femoral shaft and the neck?
Collum/inclination angle
How much is the collum/inclination angle usually but can vary with body type?
125 degrees
What is an increase in collum angle of femoral head called that causes it to be more superiorly in the acetabulum?
Coxa Valga >125 degrees
What is a decrease in the angle of femoral head called that causes it to be inferiorly placed in the acetabulum?
Coxa Vara <125 degrees
Coxa Valga or Coxa Vara?
Shortens moment arm of hip abductors, placing them in a position of disadvantage causing them to contact more vigorously, increases overall length of leg, and changes orientation of the joint force from normal vertical to one that is almost parallel to the femoral shaft, reducing weight bearing surface and increases stress across joint
Coxa Valga
Coxa valga or coxa vara?
More horizontal position of femoral head in acetabulum, increasing shear force on femoral neck, lengthens movement arm of hip abductors placing them in mechanical disadvantage, and decreases overall length of LE
Coxa Vara
What is the term for femoral alignment in the transverse plane that is an anterior position of the axis through the femoral condyles?
Anteversion
What is the term for femoral alignment in the transverse plane where the femoral neck axis is parallel or posterior to the condylar axis?
Retroversion
What is a limitation of passive hip extension caused by lack of extensibility of mm or ligaments of the hip called?
Hip FLEXion contracture
What people are hip flexion contractures common in?
People with compromised mobility - those who sit a lot
What are some compensations of hip flexion contractures?
Lower spine compensates through overextension, trunk must flex, and knee joint must flex
Strain of what mm group is the most common cause of groin pain? It could be b/c muscular imbalances that lead to fatigue or abduction overload.
Soccer players are vulnerable to this.
Adductors
What is the strongest hip flexor mm and is often strained by forced extension of the hip while it is flexed?
Iliopsoas
What mm of the quads is most commonly strained during sports like running, jumping, or kicking?
Rectus femoris
What mm group is most commonly strained, especially in running sports, and during eccentric stages of usage?
Hamstrings, specifically biceps femoris
What condition is characterized by the following:
- Repetitive stress injury as ITB creates friction when sliding over lateral femoral condyle at 30 degrees of knee flexion
- Causes reddish brown bursa
- Common in long distance runners and cyclists
Iliotibial Band Friction Syndrome
What condition is characterized by the following:
- Often called trochanteric bursitis and is common cause of lateral hip pain
- Pts have a hard time lying on their side, standing, walking, sitting, etc
- Mostly in people 40+ and moreso in women
- Though to result from thickening and thinning of tears in glutes and changes in bursa structure
Gluteal tendinopathy
What kind of bursitis is characterized by the following:
- Inflammation of one or the trochanteric bursa that are inflamed by friction b/c a short TFL
Trochanteric bursitis
What kind of bursitis is characterized by the following:
- Located b/w anterior side of joint capsule of hip and muscle/tendon junction of iliopsoas
- Cause is from acute trauma or overuse from constant hip flexion
Iliopectineal bursitis
What kind of bursitis is characterized by the following:
- Inflammation from chronic compression or trauma
- Pain with sitting in firm chair
- Affects thinner people more than obese people
- Affects women more than men
Ischial/gluteal bursitis
What kind of bursitis is characterized by the following:
- In pts 40-50 yo
- Pain in gluteal or trochanteric region
Gluteal bursitis
Fxs of the pelvis are common in what population?
Older people bc of falls. Has a high mortality rate.
Fx of what part of the pelvis is most common?
Pubic fracture
What is the intervention for a fx of the pelvis?
Get mobilized!
Do strength training and functional activities if the fx is stable.
If fx is unstable, limit weight bearing for up to 3 mo.
Fxs of the acetabulum occur primarily in what population and as a result of what?
Young adults as a result of high velocity trauma.
What is the intervention for a fx of the acetabulum?
ORIF - open reduction internal fixation
What is the 1 year mortality rate after a hip fx has been sustained?
14-58%
Which type of hip fx?
- From high energy trauma in young pts
- Often associated with multiple injuries and high rates of avascular necrosis and nonunion
Femoral neck hip fracture
Hip fx often result from what pre-existing pathology?
Osteoporosis
Which type of hip fx?
- Fx distal to femoral neck and proximal to femoral shaft
- Area where femur changes from vertical to angled bone
-Occurs bc a combo of bone fragility and decreased agility and mm tone of that area
- Surgical intervention
Intertrochanteric hip fracture
Which type of hip fx?
- Seen in older osteopenia pts after a low energy fall and in young people with high energy trauma
- 10-30% of all hip fxs
- Healing through cortical healing, so quite slow
- Surgical intervention
Subtrochanteric hip fracture
What are the 3 types of hip fxs?
Intertrochanteric
Subtrochanteric
Femoral neck fx
What condition is characterized by the femoral head temporarily loses its blood supply and starts to die?
The weakened bone gradually breaks apart and can lose its round shape. Lots of pain and stiffness
Legg-Calve-Perthes Disease
What condition is characterized by being a disorder of adolescent where the growth plate of the femoral head is damaged and slips with respect to the rest of the femur?
The head of the femur stays in the hip jt while the rest of the femur shifts. Affected leg is shortened and there is decreased IR.
Slipped capital femoral epiphysis
What is the term for insufficient containment of the femoral head by the acetabulum?
Acetabular dysplasia
T or F?
Hip preservation surgery is an aim to restore an optimal relationship between structure and joint kinematics and delaying a THA.
True - this is a cartilage restoration, arthroscopy, osteotomy
A THA is used in cases of severe joint damage from?
RA, OA, hip fx, avascular necrosis
What are common indications for a THA?
Pain, functional limitations, loss of mobility, post hip fx that has a high risk of vascular necrosis, or radiographic evidence of intra-articular disease
What is the approach to a THA called that is characterized by the following?
- Approach hip through the internal between the TFL and glut med.
- 1 or 2 small incisions
- Some portion of the hip abductor mm is released from greater trochanter and hip is dislocated ANTERIORLY
Anterolateral approach
What is the approach to a THA called that is characterized by the following?
- Most commonly used and gains access to the hip joint by splitting the glut max
- Femur is dislocated POSTERIORLY
Posterolateral approach
What is the approach to a THA called that is characterized by the following?
- Leaves the posterior portion of the glut med attached to the greater trochanter
- The preferred approach in noncompliant pts to prevent postsurgical dislocation
Direct lateral approach
Why is a minimally invasive approach to a THA the best?
Creates less damage, less incision, therefore less healing and less of a chance to mess up
What are some complications that can happen after a THA?
- DVT (risk up to 3 mo post op)
- Femoral fx
- Dislocation (in elderly women)
- Neurovascular injury (division of sciatic nerve leading to neutopathy)
- Heterotopic ossification
What are the standard precautions for a lateral or posterolateral THA approach?
- Do not cross legs (no hip ADD)
- Pillow between legs in sidelying
- No hip IR
- Do not flex hip over 90 degrees
- Use assistive device or reacher with ADLs as needed
- Combo of hip flexion, IR, and adduction are to be avoided for up to 4 mos after surgery or until physician clearance
What are the standard precautions for an anterior / anterior lateral / direct lateral THA approach?
- avoid hip flexion over 90 degrees
- avoid hip extension, adduction, and ER if a trochanteric osteotomy or glut med was incised, do not perform active, antigravity hip ABD for at least 6-8 wks or until approved by surgeon
What is the term for replacement of the articular surface of the femoral head without surgically altering the acetabular surface?
Hemiarthroplasty
In the knee, a lateral angle of fewer than 170 degrees indicates what?
Excessive genu valgum (knock-kneed)