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SPRING MSK II - Exam 2 > Pelvis and Hip- Fx thru Functional Testing > Flashcards

Pelvis and Hip- Fx thru Functional Testing Flashcards

1
Q

What are hip fractures most commonly due to?

A

trauma

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2
Q

How many hip fractures are non-traumatic and pathological?

A

<5%

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3
Q

Are hip fractures increasing in prevalence? Why or why not?

A
  • incidence increasing and proposed to reach 7-21 million per year
  • aging population, people living longer
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4
Q

Hip fractures are the MOST frequent fracture _________ to the _____

A

reporting to the ER

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5
Q

What is the average age of a hip fracture?

A

80 years old

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6
Q

What are risk factors for hip fractures?

A
  • prior fall
  • gait dysfunction (catch foot, etc.)
  • vertigo (outside spinning, influences steadiness)
  • medications influencing BP, dizziness, etc. (older population, more meds which alter vitals, cause dizziness, and potential orthostatic hypotension)
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7
Q

What is a functional questionnaire for hip fractures?

A
  • HFRS ( hip fractures recover scale)
  • tells us how well a patient will do
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8
Q

What structures are involved in a hip fracture?

A
  • BONE: most commonly femoral neck
  • Ligaments: rarely but sometimes damages with dislocations
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9
Q

What are S&S of a hip fracture in observation?

A
  • typical fx S&S
  • LE possibly shortened and in an externally rotated position
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10
Q

What special tests are there for a hip fracture?

A
  • positive patellofemoral pubic tab test
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11
Q

What types of hip fracture are there?

A
  • intertrochanteric hip fracture
  • femoral neck fracture
  • subtrochanteric hip fracture
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12
Q

What is our PT rx for hip fractures primarily treating?

A

consequences of immobilization of other tissues

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13
Q

At what time after the fx does the patient most often show up for out-patient PT?

A
  • after clinical union: cant see fx line on radiograph anymore
  • should have bony callus

** SLOWER clinical union in older populations

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14
Q

What are some other terms for adhesive capsulitis?

A

ACH or frozen hip

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15
Q

What are risk factors for adhesive capsulitis?

A
  • associated with systemic low-grade inflammation
  • thyroid disorder
  • diabetes
  • alcoholism
  • middle aged
  • biological females
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16
Q

What is the primary etiology of adhesive capsulitis?

A

unknown

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17
Q

What is the secondary etiology of adhesive capsulitis?

A

concomitant injury/pathology - such as hip fracture and period of extended inflammation and immobilization

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18
Q

What is a proposed but NOT proven contribution to adhesive capsulitis?

A

biomechanical contributions

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19
Q

What is the pathogenesis of adhesive capsulitis?

A
  • synovial inflammation to capsular fibrosis
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20
Q

What structures are involved with adhesive capsulitis?

A

hip capsule and ligaments

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21
Q

What are symptoms of adhesive capsulitis?

A

like impingement plus…
- gradual and progressive pain and loss of motion

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22
Q

What is a UNIQUE characteristic of adhesive capsulitis?

A
  • PROGRESSIVE PAIN
    gradual worsening
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23
Q

What mechanism or type of impingement will MOST likely occur with adhesive capsulitis?

A

hypomobility

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24
Q

What are signs in ROM of adhesive capsulitis?

A

multiple direction of limitations but no consensus on capsular pattern of restriction

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25
Q

What will we find with combined motions with adhesive capsulitis?

A

consistent block

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26
Q

What will we find with resisted/MMT with adhesive capsulitis?

A

possibly weak and/or painful depending on stage

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27
Q

What will we find with stress tests with adhesive capsulitis?

A

distraction possibly positive depending on stage

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28
Q

What will we find with accessory motion with adhesive capsulitis?

A

hypomobility

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29
Q

What is stage I of adhesive capsulitis?

A

Initial

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30
Q

What are symtoms of stage I, Initial, for adhesive capsulitis?

A
  • gradual onset
  • achy at rest
  • sharp with use
  • night pain common
  • unable to lie on involved side
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31
Q

What is the irritability of stage I of adhesive capsulitis?

A

HIGH

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32
Q

What will we find with ROM with stage I of adhesive capsulitis?

A

Limited but no deficit under anesthesia

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33
Q

What will the end feel be for stage I of adhesive capsulitis?

A

empty and painful

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34
Q

What is stage II of adhesive capsulitis?

A

Freezing

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35
Q

What are the symptoms of stage II, freezing, of adhesive capsulitis?

A
  • constant pain
  • particularly at night
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36
Q

What is the irritability of stage II, freezing, of adhesive capsulitis?

A

HIGH

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37
Q

What is the ROM with stage II, freezing, of adhesive capsulitis?

A

Moderate limitation, similar under anesthesia

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38
Q

What is the end feel with stage II, freezing, with adhesive capsulitis?

A

empty and painful

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39
Q

Why is the ROM the same/ similar under anesthesia with stage I and II of adhesive capsulitis?

A

capsule hasn’t become fibrotic yet, and inflammation hasn’t been around long enough to create changes
- only creates pain

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40
Q

What is happening in general from stage I to stage II of adhesive capsulitis?

A

Getting worse :(

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41
Q

What is stage III of adhesive capsulitis?

A

Frozen

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42
Q

What are the symtoms of stage III/frozen of adhesive capsulitis?

A

Stiffness > pain

43
Q

What is the irritability of stage III / frozen of adhesive capsulitis?

A

moderate

44
Q

What will we find with ROM of stage III / frozen with adhesive capsulitis?

A

severe limitations with pain at end range
- similar under anesthesia

45
Q

What is the end feel of stage III / frozen of adhesive capsulitis?

A

Firm

46
Q

What is stage IV of adhesive capsulitis?

A

thawing

47
Q

What are the symptoms of stage IV, thawing of adhesive capsulitis?

A

Minimal pain

48
Q

What is the irritability of stage IV / thawing of adhesive capsulitis?

A

low

49
Q

What will we find with ROM during stage IV, thawing, with adhesive capsulitis?

A

gradually improving

50
Q

What is the end feel during stage IV, thawing, with adhesive capsulitis?

A

Firm

51
Q

Is symptom reproduction okay with adhesive capsulitis?

A

NO

52
Q

Is there a gold standard for tests and measures for adhesive capsulitis?

A

NO, done by exclusion

53
Q

Why is early dx of adhesive capsulitis difficult?

A

Due to irritability

54
Q

What is the MOST common test and measure to determine presence of adhesive capsulitis?

A

Clinical presentation

55
Q

What are the PT rx for adhesive capsulitis?

A
  • POLICED
  • inflammatory management
  • pt education
  • promote pain free mobility
  • tissue remodeling
56
Q

What kind of patient education can we do with adhesive capsulitis?

A
  • avoid motions that cause pain in the hip
  • dont give too many instructions / rules
  • 4 stages, varying timeframes for different people
  • pain free functional activity
57
Q

What kind of JM can we do with adhesive capsulitis?

A
  • Grade III-V= moderate evidence for short and long term benefits
58
Q

What is the evidence for STM for adhesive capsulitis?

A

Moderate

59
Q

What functional ROM in flexion is required for stairs?

A

~70 degrees

60
Q

What amount of flexion is required for sit to stand and squatting?

A

~ 115 degrees

61
Q

What amount of hyperextension is required for gait?

A

~10 degrees

62
Q

What functional ROMs is ideal for MOST ADLs?

A
  • 120 degrees flexion
  • 20 degrees abduction
  • 20 degrees external rotation
  • 10 degrees hyperextension
63
Q

What characteristics does a rigid body type have?

A
  • less lumbar lordosis
  • less hip motion, especially into IR
  • less foot and ankle EV or pronation aka higher arches
64
Q

What characteristics does a flexible body type have?

A
  • more lumbar lordosis
  • more hip motion, especially into IR
  • more foot and ankle EV or pronation aka lower arches
65
Q

What activities can be correlated with a rigid body type?

A

sprinter, anerobic sports

66
Q

What activities can be correlated with a flexible body type?

A

distance runner, dancer, golf

67
Q

What happens along with right heel strike?

A
  • right hip maximally flexed to 30 degrees with adduction and external rotation
  • right innominate posterior rotation
68
Q

What happens along with right foot flat to mid-stance?

A
  • right hip extension begins with right innominate anterior rotation
  • right hip internal rotation and adduction as pelvis begins to rotate right on right femur
  • eccentric then isometric right hip abductors and external rotators for right unilateral stance
69
Q

What happens along with right heel off to toe-off?

A
  • right hip extension, abduction and internal rotation
  • maximal potential energy occurs in lengthened right hip capsule/ligaments and hip flexors
  • right psoas lengthening further assists with trunk right side bend, extension and left rotation if T10 rotation WNL
70
Q

What happens along with right acceleration to mid-swing?

A
  • release of lengthened capsule, ligament, and psoas creating hip flexion
71
Q

What are the three storehouses of potential energy?

A
  1. non- contractile tissue
  2. contractile tissue
  3. T10 rotation allows psoas to assist with trunk motion and early and mid-swing of LE - like upper T-spine motion with lower trap
72
Q

What is a example of non-contractile tissue as a storehouse of potential energy?

A

hip capsule and ligaments lengthen with hyperextension

73
Q

What is an example of contractile tissue as a storehouse of potential energy?

A

hip flexors lengthen, particularly psoas and iliocapsularis

74
Q

IF we dont maintain out base of support, we _____

A

Fall

75
Q

If we cant transfer energy, we become ___________

A

Inefficient

76
Q

What do excessive ground reaction or landing forces lead to?

A

traumatic or repetitive stress injury

77
Q

What does more friction generate?

A

additional heat (blisters) and prevents motion (trauma)

78
Q

What does a lack of stored potential energy of lengthened muscles, ligaments and capsules contribute to?

A

Repetitive stress of overuse injury

79
Q

What are some characteristics of LE induced (NOT TRUNK) walking?

A
  • no give so increased impact
  • spinning on the ball of the foot (increased friction)
  • actively advancing non-WB LE
  • trunk follows the leading LE
80
Q

is LE induced walking efficient? Effective?

A

Effective yes, efficient no

81
Q

What is a primary driver of gait?

A

the trunk

82
Q

What is NOT essential for locomotion?

A

Extremities

83
Q

Can we still walk without extremities?

A
  • still walk without arm swing
  • we can locomote while long sitting
84
Q

What do the extremities provide with locomotion?

A

extra leverage and energy savings for more efficient gait

85
Q

What are the functional goals with optimal human gait? (basic)

A
  • minimize impact and friction
  • maximize PE
86
Q

We want to be ________ not just ___________

A

efficient not just effective

87
Q

What can effectiveness derive from?

A

Compensations

88
Q

What do compensations during gait do?

A

decrease efficiency and expend NOT only more but likely the wrong injury = injury

89
Q

What are common areas of excessive stress if storehouses of potential energy do NOT occur?

A
  • hip joint
  • hip flexor overuse
  • lower lumbar spine under more stress
90
Q

Why is the hip joint a common area of excessive stress if storehouses of potential energy do NOT occur

A

decreased cartilage integrity by limited motion

91
Q

Why is hip flexor overuse a common area of excessive stress if storehouses of potential energy do NOT occur?

A

with shorter strides
- due to increased active hip flexion
- demonstrated with iliocapsulatis

92
Q

Why is the lumbar spine a common area of excessive stress if storehouses of potential energy do NOT occur?

A
  • with lack of T10 rotation and / or hip hyperextension
93
Q

What are some functional tests for return to sport or pre-sport screening?

A

Quantity and Quality
- limb symmetry
- agility tests

94
Q

What should we know about functional tests with hip pathologies?

A

Not studied

95
Q

What is a functional test for predicting LE basketball injury?

A

SEBT (star excursion balance test)
- looking for asymmetry or pain

96
Q

What is the single limb squat test looking for?

A

asymmetry or pain

97
Q

What is the FMS (functional movement screen) used for?

A

to predict non-contact injury

98
Q

What are the unilateral and bilateral hop tests? What are they used for?

A
  • cross over
  • 3 hop forward and lateral
  • normative and biological sex values in young athletes
  • acceptable threshold ≥ 90% of uninvolved developed with ACL injuries
99
Q

What are some other jump tests that can be used as a functional test for hip pathology?

A
  • Drop vertical jump
  • Tuck jump
100
Q

What are agility tests used for with hip pathologies? What is a con?

A
  • may have value in athletic population because of sport specific testing

CON
- not able to discriminate between injured and non-injured limbs

101
Q

What is a practice progression for hip pathologies?

A
  • predictable and non-contact
  • unpredictable and non-contact
  • predictable and contact
  • unpredictable and non-contact
    may need to consider distance, time, pace, intensity, etc. as well
102
Q

What is a predictor of LE injury?

A

Hip ER weakness

103
Q

What is highly active as a stabilizer for ER especially through hip extension?

A

Piriformis

104
Q

What is a ER only when the hip is flexed?

A

Glut max

SPRING MSK II - Exam 2 (6 decks)

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