Pelvis and Hip 4 Flashcards
Etiology of hip fx
usually traumatic
<5% non traumatic
epidemiology of hip fx
incidence increasing; proposed increase of 7-21 million per year world wide by 2050
most frequent fx presenting to ER
avg age = 80 years
important factor to add to interventions for older individuals (especially those with fx)
balance
risk factors for hip fx
prior fall
gait dysfunction
vertigo
meds influencing BP, dizziness, etc
functional questionaires for hip fx
HFRS (hip fx recovery scale)
structure involved with a hip fx
bone- most commonly femoral neck
ligaments - rare time they are likely damaged along with dislocations
S&S of hip fx
typical fx S&S
observation of LE possibly shortened and in an ER position
special tests = + for patellofemoral pubic tap test
what are you primarily treating a hip fx for
primarily treating consequences of immobilization of other tissues
what might you see with a pt that comes to PT 1-3 months post fx
limited ROM: not super painful b/c no longer in inflammatory phase (1-2 wks)
firm/elastic end feels
pt guarding/fear of mvmt
other names for adhesive capsulitis at the hip
frozen hip
or
ACH
risk factors for adhesive capsulitis
associated with systemic low grade inflammation (thyroid disorder, diabetes, alcoholism)
middle aged
female
etiology of adhesive capsulitis
primary is unknown
secondary = cocontaminant pathology
proposed biomechanical contributions (but NOT proven)
pathogenesis of adhesive capsulitis
synovial inflammation to capsular fibrosis
structures involved with adhesive capsulitis
hip capsule and ligaments
S&S of adhesive capsulitis
gradual and progressive pain and loss of motion
no consensus on capsular pattern
tests and measures for adhesive capsulitis
clinical presentation
arthroscopy
biopsies
aspirations for inflammatory markers
stage 1 of adhesive capsulitis
gradual onset
achy at rest
sharp pain with use
night pain
cant lie on involved side
highly irritable
limited ROM but none under anesthesia
empty painful endfeel
stage 2 adhesive capsulitis
constant pain especially at night
high irritability
moderate limitation in ROM; similar under anesthesia
empty/painful end feel
stage 3 frozen shoulder
stiffness more than pain
moderate irritability
severe ROM limits with pain at end range; similar under anesthesia
empty painful end feel
stage 4 frozen shoulder
minimal pain
low irritability
ROM gradually improves
capsular pattern of restriction
PT/MD Rx for adhesive capsulitis
exercises away from pain or right up to
low load, 3x10
grade I-II joint mobs at most
PROM to demonstrate range you want them in
refer to shoulder powerpoint
flexion required for stairs
70 degrees
flexion required for sit to stand
115 deg
hyperext needed for gait
10 deg
ideal ROM for most ADLs
120 flex
20 abd
20 ER
10 Hyperext
what happens at the hip during R heel strike
R hip maximally flexed to 30 deg with ADD and ER
R inominate post RT
what happens at the hip from R foot flat to midstance
R hip ext begins with R innominate ant RT
R hip IR and ADD as pelvis begins to rotate R on the R femur
what happens at the hip from R heel off to toe off
R hip ext, ABD, and IR
max potential energy occurs in lengthened R hip capsule/ligaments and hip flexors
