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MS Test 3: Lower Quarter > PT Management of Selected Hip Pathology > Flashcards

PT Management of Selected Hip Pathology Flashcards

1
Q

What are important features of adductor longus anatomy?

A

37.9% tendon 62.1 % muscle

poorly vascularized

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2
Q

What is common MOI for adductor injury?

A

eccentric load from hip extension to hip flexion, cutting and kicking

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3
Q

What are risk factors for adductor injury?

A

limited flexibility, muscle imbalance (most common), failed acute management

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4
Q

What is conservative management of adductor injury?

A

relative rest, strengthening adductor rectus axis, pelvic stability (core, glutes, lower abs)

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5
Q

What is common presentation of iliopsoas injury?

A

Bursa: internal snapping hip, tenderness, risk for labral tear

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6
Q

What is common presentation of a glute med/min tendinopathy?

A

common in females, pain on palpation and pain with sidelying

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7
Q

What is glute med/min tendinopathy often misdiagnosed as?

A

trochanteric bursitis

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8
Q

What is treatment for glute med/min injury?

A

address causing factors like ITB/TFL contracture (overworked from weak glute med), hip flexor contracture, pelvic obliquity, glute med weakness

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9
Q

Why do most hamstring injuries occur?

A

weakness in glute med.

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10
Q

What is common MOI for HS ?

A

sprinting during terminal swing/ preparing for contact- HS are lengthening but must also decelerate limb

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11
Q

What HS is put under greatest pressure during this MOI?

A

Biceps femoris

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12
Q

What is key of HS for both prevention and rehab?

A

eccentric ability/control

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13
Q

What is another common MOI for HS?

A

extreme stretch, hip flexion with knee extension like with soccer players or dancers

semi membranous and proximal free tendon

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14
Q

What area of HS requires longer time for rehab?

A

more proximal to ischial tube as there is less blood flow to this area

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15
Q

What must PT screen if pt has a proximal HS injury?

A

avulsion fracture

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16
Q

What are intrinsic risk factors for HS injury?

A

history of prior strain, older age, muscle weakness, flexibility(still unclear if true)

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17
Q

What potential muscle imbalance relationship must be looked at in HS pts?

A

greater than 20% muscle weakness in eccentric HS than concentric quads increase your risk by 4 fold for HS injury

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18
Q

What type of rehab has been shown in literature in providing better HS recovery?

A

progressive agility training and Trunk stabilization

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19
Q

According to JOSPT what is recommended for phase 1 of HS injury recovery?

A

protection- avoid stretching which will create more scar tissue, pain free movement

ICE-2-3 times daily

NSAIDS- initial time following injury but long term use could damage ms function

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20
Q

What are good therex in phase 1 according to JOSPT?

A

TA work, SL balance for glute work, short stride stepping drills

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21
Q

Phase 2 according to JOSPT?

A

full pain free ROM, ice only after exercise, no NSAIDS

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22
Q

Therex during phase 2 according to JOSPT?

A

submax eccentric movements for fiber regeneration, TA work, focus on transverse and frontal plane before sagittal work,

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23
Q

What is criteria to move onto phase 3 according to JOSPT?

A

full strength w/o pain prone knee flexed to 90, forward and backward jogging 50% effort with no pain

24
Q

What is phase 3 according to JOSPT?

A

unrestricted ROM, avoid sprinting, shouldn’t need Ice and no NSAIDS use

25
Q

What is Therex for phase 3 according to JOSPT?

A

transverse stabilization, unilateral postures, eccentric work at end range , agility and sport specific work

26
Q

What is important to see an athlete do during functional sport specific activity?

A

are they willing to cut on weak leg when asked to unexpectedly change direction

27
Q

Why do muscle strain injuries likely occur?

A

incomplete rehab, impaired healing response- fibrosis at injury site due to fibers not being straight (soft tissue work)

28
Q

Why is eccentric work preferred for muscle injuries?

A

its remodels collagen fibers and builds hypertrophy as well as neural activation

29
Q

Why does muscle activation help reduce injuries?

A

it increases energy required to strain a muscle to failure, ability of muscle to resist length is important (eccentric control)

30
Q

What is important to remember about early recovery for a HS surgery?

A

avoid hip flexion greater than 60 degrees

31
Q

When can strengthening begin after HS surgery?

A

6-12 weeks

32
Q

What is pt presentation of trochanteric bursitis?

A

Aching pain lateral aspect of hip – Tenderness at greater trochanter – 40-60 year-old
– History of OA or RA

33
Q

What is tx for Trochanteric bursitis?

A
  • ITB restrictoin
  • Iliopsoas restriction
  • Gluteal weakness
34
Q

Why do flexion contractures occur?

A

– Iliopsoas tightness
– Rectus femoris tightness
– Tensor fascia latae tightness
• Anterior capsuloligamentous contracture

35
Q

What is PP of flexion contracture?

A

Osteoarthritis
– History of hip injury
– Flexed postures (sitting at desk all day)

36
Q

What is consequence of flexion contracture?

A 
– Load shifted to a region
with thinner hyaline cartilage
• Femur & acetabulim
– Anterior tilt of pelvis
– ↑ Lumbar lordosis
37
Q

How can you dx flexion contracture?

A

Thomas Test/Modified TT

• Eliminate lumbar lordosis – Flex opposite hip
– Posterior pelvic tilt
• Extend hip

38
Q

What is hip OA?

A

Disorder of synovial joint
– Deterioration of articular cartilage & new bone formation

dx: with X-ray

39
Q

What are sx of hip OA?

A

– Stiffness
– Pain
Lateral hip, anterior thigh, knee, groin

40
Q

What are common causes of Hip OA?

A

• Primary(20%)
– No predisposing mechanical factor

• Secondary(80%)
– End result of a disease process
• Osteonecrosis
• Legg-Calve-Perthes Disease
• Dysplasia
• Slipped capital femoral epiphysis • Congenital coxa vara / coxa valga • Hip fracture
41
Q

What is goals of tx for hip OA?

A

• Maintain function • Relieve symptoms • Prevent deformity
• Education
– Hip joint protection

42
Q

What is areas to address for hip OA?

A

– Reduce Inflammation
• Responsible for pain

– improve Joint alignment
– increase ROM

–improve Muscle length and Muscle strength

43
Q

What are different ways to protect the hip joint?

A

use a bag pack to move weight posteriorly, body weight reduction (pool, swimming, upper body), assistive device use

44
Q

What happens if you lose only 1 pound?

A

3 pound reduction load on hip

45
Q

What are two different types of hip replacement procedures?

A

cemented vs uncemented

46
Q

What is important features of cemented rehab?

A

Full WB immediately

• Potential for loosening due to cement

47
Q

What is WB status for uncemented replacement ?

A

delayed WB

48
Q

What are different types of THA and what are movements to avoid with each?

A

Posterior
– Flexion, Adduction, IR
– External rotators divided

• Anterior
– Extension, ER – Minimal incision

• Direct Lateral – None
– Low dislocation rate
– Abductor mechanism impacted

49
Q

What are complications from THA?

A 
Early Complications
• Thromboembolic event – DVT
• Infection
– Rate = 1%
• Dislocation
– ↑ risk with posterior approach
– Pseudocapsule formed at 6 months
– Late Complications
• Implant loosening
50
Q

What is mortality rate for hip fractures for elder population?

A

20% within 1 year die

51
Q

What is examination for hip fx in acute care?

A 
• AcuteCare – DVT risk-
• Wells Predictor Rules – Bed mobility
– WB status
– Transfer ability
– Gait safety
– D/C planning
52
Q

What is interventions for hip fx in acute care?

A

– Ankle pumps, quad and glute sets
– Plan the room for transfers and gait
– Appropriate assistance with gait
– AD choice

53
Q

What is score for Well that would likely indicate a DVT?

A

3 or more

54
Q

What is Wells DVT clinical predictor scale?

A 
Active cancer
• Paralysis, immobilization
• Bedridden, major surgery
• Local tenderness
smoking, long recent travel
55
Q

What is tx for hip fracture for subacute and chronic stages?

A 
• Acute Care
– Out of bed, safe gait, D/C planning
• Sub Acute Care
– Gait and transfer ability and endurance – ADL adaptations
– Plan for return home ( if possible)
• ChronicCare
– Strength, gait, ADL issues
56
Q

What is Leg Calve Perth’s dz?

A

Bloodsupplytoheadoffemurdisrupted – Subsequent fracture with poor healing
• Unknown cause
• 4-8 year-old boys most common • Gradualonsetofpain
• Shortleg
• Recoverymaytake2years – Bone remodeling

57
Q

What is Slipped capped epiphysis?

A

– Adolescent males – Overweight
– Knee or groin pain – Short limb

MED EMERGNCY

MS Test 3: Lower Quarter (10 decks)

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