PT Management of Selected Hip Pathology Flashcards
What are important features of adductor longus anatomy?
37.9% tendon 62.1 % muscle
poorly vascularized
What is common MOI for adductor injury?
eccentric load from hip extension to hip flexion, cutting and kicking
What are risk factors for adductor injury?
limited flexibility, muscle imbalance (most common), failed acute management
What is conservative management of adductor injury?
relative rest, strengthening adductor rectus axis, pelvic stability (core, glutes, lower abs)
What is common presentation of iliopsoas injury?
Bursa: internal snapping hip, tenderness, risk for labral tear
What is common presentation of a glute med/min tendinopathy?
common in females, pain on palpation and pain with sidelying
What is glute med/min tendinopathy often misdiagnosed as?
trochanteric bursitis
What is treatment for glute med/min injury?
address causing factors like ITB/TFL contracture (overworked from weak glute med), hip flexor contracture, pelvic obliquity, glute med weakness
Why do most hamstring injuries occur?
weakness in glute med.
What is common MOI for HS ?
sprinting during terminal swing/ preparing for contact- HS are lengthening but must also decelerate limb
What HS is put under greatest pressure during this MOI?
Biceps femoris
What is key of HS for both prevention and rehab?
eccentric ability/control
What is another common MOI for HS?
extreme stretch, hip flexion with knee extension like with soccer players or dancers
semi membranous and proximal free tendon
What area of HS requires longer time for rehab?
more proximal to ischial tube as there is less blood flow to this area
What must PT screen if pt has a proximal HS injury?
avulsion fracture
What are intrinsic risk factors for HS injury?
history of prior strain, older age, muscle weakness, flexibility(still unclear if true)
What potential muscle imbalance relationship must be looked at in HS pts?
greater than 20% muscle weakness in eccentric HS than concentric quads increase your risk by 4 fold for HS injury
What type of rehab has been shown in literature in providing better HS recovery?
progressive agility training and Trunk stabilization
According to JOSPT what is recommended for phase 1 of HS injury recovery?
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
What are good therex in phase 1 according to JOSPT?
TA work, SL balance for glute work, short stride stepping drills
Phase 2 according to JOSPT?
full pain free ROM, ice only after exercise, no NSAIDS
Therex during phase 2 according to JOSPT?
submax eccentric movements for fiber regeneration, TA work, focus on transverse and frontal plane before sagittal work,
What is criteria to move onto phase 3 according to JOSPT?
full strength w/o pain prone knee flexed to 90, forward and backward jogging 50% effort with no pain
What is phase 3 according to JOSPT?
unrestricted ROM, avoid sprinting, shouldn’t need Ice and no NSAIDS use
What is Therex for phase 3 according to JOSPT?
transverse stabilization, unilateral postures, eccentric work at end range , agility and sport specific work
What is important to see an athlete do during functional sport specific activity?
are they willing to cut on weak leg when asked to unexpectedly change direction
Why do muscle strain injuries likely occur?
incomplete rehab, impaired healing response- fibrosis at injury site due to fibers not being straight (soft tissue work)
Why is eccentric work preferred for muscle injuries?
its remodels collagen fibers and builds hypertrophy as well as neural activation
Why does muscle activation help reduce injuries?
it increases energy required to strain a muscle to failure, ability of muscle to resist length is important (eccentric control)
What is important to remember about early recovery for a HS surgery?
avoid hip flexion greater than 60 degrees
When can strengthening begin after HS surgery?
6-12 weeks
What is pt presentation of trochanteric bursitis?
Aching pain lateral aspect of hip – Tenderness at greater trochanter – 40-60 year-old
– History of OA or RA
What is tx for Trochanteric bursitis?
- ITB restrictoin
- Iliopsoas restriction
- Gluteal weakness
Why do flexion contractures occur?
– Iliopsoas tightness
– Rectus femoris tightness
– Tensor fascia latae tightness
• Anterior capsuloligamentous contracture
What is PP of flexion contracture?
Osteoarthritis
– History of hip injury
– Flexed postures (sitting at desk all day)
What is consequence of flexion contracture?
– Load shifted to a region with thinner hyaline cartilage • Femur & acetabulim – Anterior tilt of pelvis – ↑ Lumbar lordosis
How can you dx flexion contracture?
Thomas Test/Modified TT
• Eliminate lumbar lordosis – Flex opposite hip
– Posterior pelvic tilt
• Extend hip
What is hip OA?
Disorder of synovial joint
– Deterioration of articular cartilage & new bone formation
dx: with X-ray
What are sx of hip OA?
– Stiffness
– Pain
Lateral hip, anterior thigh, knee, groin
What are common causes of Hip OA?
• 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
What is goals of tx for hip OA?
• Maintain function • Relieve symptoms • Prevent deformity
• Education
– Hip joint protection
What is areas to address for hip OA?
– Reduce Inflammation
• Responsible for pain
– improve Joint alignment
– increase ROM
–improve Muscle length and Muscle strength
What are different ways to protect the hip joint?
use a bag pack to move weight posteriorly, body weight reduction (pool, swimming, upper body), assistive device use
What happens if you lose only 1 pound?
3 pound reduction load on hip
What are two different types of hip replacement procedures?
cemented vs uncemented
What is important features of cemented rehab?
Full WB immediately
• Potential for loosening due to cement
What is WB status for uncemented replacement ?
delayed WB
What are different types of THA and what are movements to avoid with each?
Posterior
– Flexion, Adduction, IR
– External rotators divided
• Anterior
– Extension, ER – Minimal incision
• Direct Lateral – None
– Low dislocation rate
– Abductor mechanism impacted
What are complications from THA?
Early Complications • Thromboembolic event – DVT • Infection – Rate = 1% • Dislocation – ↑ risk with posterior approach – Pseudocapsule formed at 6 months – Late Complications • Implant loosening
What is mortality rate for hip fractures for elder population?
20% within 1 year die
What is examination for hip fx in acute care?
• AcuteCare – DVT risk- • Wells Predictor Rules – Bed mobility – WB status – Transfer ability – Gait safety – D/C planning
What is interventions for hip fx in acute care?
– Ankle pumps, quad and glute sets
– Plan the room for transfers and gait
– Appropriate assistance with gait
– AD choice
What is score for Well that would likely indicate a DVT?
3 or more
What is Wells DVT clinical predictor scale?
Active cancer • Paralysis, immobilization • Bedridden, major surgery • Local tenderness smoking, long recent travel
What is tx for hip fracture for subacute and chronic stages?
• 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
What is Leg Calve Perth’s dz?
Bloodsupplytoheadoffemurdisrupted – Subsequent fracture with poor healing
• Unknown cause
• 4-8 year-old boys most common • Gradualonsetofpain
• Shortleg
• Recoverymaytake2years – Bone remodeling
What is Slipped capped epiphysis?
– Adolescent males – Overweight
– Knee or groin pain – Short limb
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