Pelvis and Hip 4

Question 1

Etiology of hip fx

Answer 1

usually traumatic

<5% non traumatic

Question 2

epidemiology of hip fx

Answer 2

incidence increasing; proposed increase of 7-21 million per year world wide by 2050

most frequent fx presenting to ER

avg age = 80 years

Question 3

important factor to add to interventions for older individuals (especially those with fx)

Answer 3

balance

Question 4

risk factors for hip fx

Answer 4

prior fall

gait dysfunction

vertigo

meds influencing BP, dizziness, etc

Question 5

functional questionaires for hip fx

Answer 5

HFRS (hip fx recovery scale)

Question 6

structure involved with a hip fx

Answer 6

bone- most commonly femoral neck

ligaments - rare time they are likely damaged along with dislocations

Question 7

S&S of hip fx

Answer 7

typical fx S&S

observation of LE possibly shortened and in an ER position

special tests = + for patellofemoral pubic tap test

Question 8

what are you primarily treating a hip fx for

Answer 8

primarily treating consequences of immobilization of other tissues

Question 9

what might you see with a pt that comes to PT 1-3 months post fx

Answer 9

limited ROM: not super painful b/c no longer in inflammatory phase (1-2 wks)

firm/elastic end feels

pt guarding/fear of mvmt

Question 10

other names for adhesive capsulitis at the hip

Answer 10

frozen hip

or

ACH

Question 11

risk factors for adhesive capsulitis

Answer 11

associated with systemic low grade inflammation (thyroid disorder, diabetes, alcoholism)

middle aged

female

Question 12

etiology of adhesive capsulitis

Answer 12

primary is unknown

secondary = cocontaminant pathology

proposed biomechanical contributions (but NOT proven)

Question 13

pathogenesis of adhesive capsulitis

Answer 13

synovial inflammation to capsular fibrosis

Question 14

structures involved with adhesive capsulitis

Answer 14

hip capsule and ligaments

Question 15

S&S of adhesive capsulitis

Answer 15

gradual and progressive pain and loss of motion

no consensus on capsular pattern

Question 16

tests and measures for adhesive capsulitis

Answer 16

clinical presentation
arthroscopy
biopsies
aspirations for inflammatory markers

Question 17

stage 1 of adhesive capsulitis

Answer 17

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

Question 18

stage 2 adhesive capsulitis

Answer 18

constant pain especially at night

high irritability

moderate limitation in ROM; similar under anesthesia

empty/painful end feel

Question 19

stage 3 frozen shoulder

Answer 19

stiffness more than pain

moderate irritability

severe ROM limits with pain at end range; similar under anesthesia

empty painful end feel

Question 20

stage 4 frozen shoulder

Answer 20

minimal pain

low irritability

ROM gradually improves

capsular pattern of restriction

Question 21

PT/MD Rx for adhesive capsulitis

Answer 21

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

Question 22

flexion required for stairs

Answer 22

70 degrees

Question 23

flexion required for sit to stand

Answer 23

115 deg

Question 24

hyperext needed for gait

Answer 24

10 deg

Question 25

ideal ROM for most ADLs

Answer 25

120 flex
20 abd
20 ER
10 Hyperext

Question 26

what happens at the hip during R heel strike

Answer 26

R hip maximally flexed to 30 deg with ADD and ER

R inominate post RT

Question 27

what happens at the hip from R foot flat to midstance

Answer 27

R hip ext begins with R innominate ant RT

R hip IR and ADD as pelvis begins to rotate R on the R femur

Question 28

what happens at the hip from R heel off to toe off

Answer 28

R hip ext, ABD, and IR

max potential energy occurs in lengthened R hip capsule/ligaments and hip flexors