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SPRING MSK II - Exam 2 > Pelvis and Hip - Hypermobility through IPI > Flashcards

Pelvis and Hip - Hypermobility through IPI Flashcards

1
Q

What is hypermobility in the hip?

A

excessive arthrokinematics/ joint play (guiding motion)

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2
Q

What are the traumatic etiologies of hypermobility of hip?

A
  • fx and ligamentous tear
  • labral
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3
Q

What are the atraumatic etiologies of hypermobility of the hip?

A
  • extreme motions in sports
  • labral tear with FAIS/IPI
    -systemic connective tissue disorder
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4
Q

What are bone abnormalities for hypermobilities?

A
  • shallow acetabulum
  • inferior acetabular insufficiency
  • excessive femoral version or torsion
  • excessive femoral neck angle
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5
Q

What are some femoral torsions in the transverse plane?

A
  • the angle between the femoral condyles and femoral head and neck
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6
Q

What is excessive ante version?

A

Toeing in

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7
Q

What is excessive retroversion?

A

Toeing out

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8
Q

What are the frontal plane angles that we should be concerned with?

A

The angle between the shaft of the femur and the neck

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9
Q

What is coxa valga?

A

-larger angle of inclination
- leads to gene vara or bow-legged position

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10
Q

What is coxa vara?

A
  • smaller angle of inclincation
  • leads to gene valga or knock-kneed position
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11
Q

What is the prevalence of hip hypermobility?

A
  • inconsistent biological sex differences
  • 5-35% of those with hip joint pain
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12
Q

What are risk factors for hypermobilitY??

A
  • genetics
  • injury
  • nature of pt’s activites
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13
Q

What are some activities that can cause or contribute to hip hypermobliity?

A
  • running
  • ballet
  • golf
  • hockey
  • soccer
  • excessive rotation, flexion, hyperextension
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14
Q

What are symptoms of hypermobility?

A

like impingement due to hypermobility plus:
- anterior groin or lateral hip pain
- popping, locking or snapping present
- feeling of instability, especially when squatting

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15
Q

What are some signs of hypermobility in the hip?

A

like impingement due to hypermobility plus:
- ROM: Hip IR> 30˚ at 90˚ flexion
- combined motion: possible inconsistent block

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16
Q

What special tests are there for hip hypermobility?

A
  • Hip apprehension
  • ligaments teres test possibly postitive
  • specific ligament tests likely positive
  • abnormal femoral version or torsion
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17
Q

What is the hip apprehension test?

A

in prone move hip into ext with ER and ABD while applying antinf force on femur (specific to pubofemoral ligament test)

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18
Q

What is the PT rx focus for hip hypermobility?

A
  • primary focus is on cartilage integrity and stabilization
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19
Q

What is regional interdependence?

A
  • theory that differing body regions are biomechanically and neurophysiologically interdependent and impairment into one region can contribute to impairment in another, particularly if persistent
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20
Q

What may play a role in regional interdependence?

A

central mechanisms such as the motor cortex

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21
Q

What is the predominant innervation to the L4-S1 Z joints?

A

L4 dorsal rami

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22
Q

What is the predominant and MOST consistent innervation to the L4-S1 discs?

A

The L1, 2 dorsal root ganglia and L4 and L5 sinuvertebral nerves

23
Q

What are the iliolumbar ligaments at L5 innervated by?

A

L1-4 spinal nerves

24
Q

What happens if any of the L4-S1 joints are persistently hypermobile/unstable?

A

The L1-4 nerves are more likely to become sensitized and excessively recruit the hip flexors

25
Q

What are the primary hip flexors?

A
  • Iliopsoas
  • Rectus Femoris
  • TFL
  • Iliocapsularis
26
Q

What innervates the iliopsoas?

A

L1-4

27
Q

What does the iliopsoas do?

A
  • primarily a hip flexor and trunk stabilizer
  • attaches to iliocapsularis
28
Q

What does the iliocapsularis do?

A
  • primarily a dynamic stabilizer for capsule
  • also a hip flexor
29
Q

What is the innervation of the iliocapsularis?

A
  • L2-4
30
Q

What does the iliocapsularis attach to?

A
  • the ilipsoas, anteromedial capsule and rectus femoris
31
Q

What is the innervation to the rectus femoris?

A
  • L2-4
32
Q

What does the rectus femoris attach to?

A
  • attaches to the capsule
  • capsule attaches to the labrum
33
Q

What o’clock is the IPI on the right hip?

A

3 o’clock

34
Q

What o’clock is the IPI on the left hip?

A

9 o’clock

35
Q

What is the etiology of the L4-S1 regional interdependence?

A
  • L4-S1 hypermobility/instability
  • MOST common segments
36
Q

What is the imbalance of muscles that lead to L4-S1 regional interdependence?

A
  • excessively recruited hip flexors that share innervation of L1-4
  • inhibition of hip extensors and abductors
37
Q

What happens to excessively recruit hip flexors that share innervation of L1-4?

A
  • attach to capsule and labrum
  • excessive traction on antmed portion (3 or 9 o’clock position depending on hip)
  • may lead to capsulitis and labral attrition without bony changes like with FAIS
38
Q

Why is the L4-S1 regional interdependence self perpetuating without addressing the lumbar stabilization?

A
  • iliopsoas is a stabilizer of the lordosis in standing
  • Maintain size or even hypertrophies in those with LBP indicating continued and excessive recruitment
39
Q

What happens with an excessively recruited Ilipsoas?

A

an further add to the anterior shearing MOST often occurring with lumbar hypermobility/instability

40
Q

What is ilipsoas impingement?

A
  • impingement without dysplasia or bony changes
41
Q

What is the etiology of IPI?

A
  • not fully clear
  • conditions that lead to excessive hip flexor recruitment
  • lumbar hypermobility / instability with regional interdependence
42
Q

What are symptoms of Iliopsoas impingement?

A
  • like FAIS with labral involvement
  • possible lumbar hypermobility/instability symptoms if LB is also aggravated
43
Q

What are signs of Iliopsoas impingement?

A

like FAIS with the following additions
- Passive ROM
* IR limitation at 90 degrees of flexion
* hip maltracking at 90 degrees

44
Q

Why is there IR limitation at 90 degrees of flexion with IPI?

A
  • due to inhibition and hypertonicity of extensors or primarily Glut max which is also the main external rotator at 90 degrees of flexion
  • light resistance during IR PROM that is NOT speed dependent
45
Q

What is hip maltracking due to?

A
  • inhibition and hypertonicity of piriformis that is an abductor at 90 degrees of flexion
  • light resistance into flexion PROM if deviation NOT allowed that is not speed dependent
46
Q

What will we find in resisted testing with IPI?

A
  • possible hip ER inhibition at 90˚ of flexion due to glut max inhibition bc it is the MAIN ER at 90˚ of flexion
47
Q

What can happen to the hip extensors with IPI?

A
  • possible inhibition of hip extensors, including quad dominant squatting pattern (hip ext inhibited knee ext excessively recruiting)
48
Q

What can happen to the abductors with IPI resisted testing?

A

inhibited abductors

49
Q

What will we find with palpation with IPI?

A
  • TTP over anterior hip region at 3 or 9 o’clock position depending on hip
  • inhibited muscles develop protective hypertonicity and tightness at rest
50
Q

What will we find in our thoracolumbar scan and biomechanics exam findings for IPI?

A
  • possible lumbar hypermobility/instability
51
Q

What is the PT rx for IPI?

A
  • tissue/cartilage integrity
  • address inhibited muscles
52
Q

What is culprit rx for IPI?

A
  • for lumbar hypermobility/instability
53
Q

What is victim rx for IPI?

A
  • like FAIS rx
54
Q

What is MD rx for IPI?

A

partial iliopsoas surgical release

SPRING MSK II - Exam 2 (6 decks)

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