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MSPT > The Hip > Flashcards

The Hip Flashcards

1
Q

Pathologies of the hip are highly subjective to ______?

A

Regional Interdependence

It is not uncommon for pts. to have LBP that mimics hip pain and vice versa

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2
Q

What are 6 medical history/conditions that may contribute to hip pain?

A
  1. Back pain
  2. Hip sprains/fractures,
  3. Congenital abnormalities
  4. Known hip osteoarthritis
  5. History of slipped capital femoral epiphysis (SCFE)
  6. History of Legg Calve Perthes disease as a child?
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3
Q

True or False: Tenderness to palpation should be assessed at the beginning of an examination

A

FALSE

Save tenderness to palpation to end of exam so that finding does not skew your examination

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4
Q

List 5 muscles for which a muscle length examination should be performed for when addressing pathologies at the hip.

A
  1. Iliopsoas
  2. Rectus femoris
  3. Hamstrings
  4. TFL/ITB
  5. Piriformis
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5
Q

Inferior glide is done to increase ______ ROM at the hip.

A

Abduction

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6
Q

Posterior glide is done to increase ______ ROM at the hip.

A

flexion and internal rotation

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7
Q

Anterior glide is done to increase ______ ROM at the hip.

A

Extension and external rotation

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8
Q

Posterolateral glide is done to increase ______ ROM at the hip.

A

Internal rotation

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9
Q

Lateral glide is done to increase ______ ROM at the hip.

A

Adduction and internal rotation

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10
Q

What structure must be cleared prior to administering a special test on the hip?

A

Must clear the LUMBAR SPINE

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11
Q

What are four common sites of avulsion fractures?

A
  1. ASIS
  2. AIIS
  3. Lesser trochanter
  4. Ischial tuberosity
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12
Q

Where do stress fractures typically occur at the hip?

A

Femoral Neck

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13
Q

What are the 7 criteria used to diagnose hip OA?

A
  1. Age 50 years or older
  2. Moderate anterior/lateral hip pain during WB
  3. Morning stiffness that lasts for < 1 hour after wakening
  4. Hip IR PROM is < by at least 24 deg OR limited hip IR and flexion PROM is < by at least 15 deg compared with the unaffected hip
  5. Increase in pain with hip IR PROM
  6. Absence of signs/ symptoms inconsistent with hip OA
  7. NOTE THE ABSENCE OF A CAPSULAR PATTERN AS A DIAGNOSTIC CRITERIA
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14
Q

What are 5 things that should be included in an examination to aid in generating a PT diagnosis?

A
  1. Demographics
  2. Pain (VAS)
  3. ‘What activities make the patient worse?’
  4. Gait
  5. Passive range of motion
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15
Q

List 4 functional tests that are relevant to administer on a patient with hip pain.

A
  1. WOMAC
  2. 6MWT
  3. TUG
  4. Timed SLS
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16
Q

List 4 areas to consider providing patient education on in patients with hip pathologies.

A
  1. WB activity modification
  2. Methods of unloading arthritic joints
  3. Exercise
  4. Weight loss (if overweight)
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17
Q

Patients should receive training in what 3 areas?

A
  1. Functional training
  2. Balance training
  3. Gait training
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18
Q

Hip __(1)___ PROM and __(3)___ strength should be checked for impairment prior to prescribing flexibility, strengthening and endurance exercises.

A

Hip Extension PROM

Hip abductor, extensor and ER strength

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19
Q

What modality has been recommended in treating hip OA? Parameters?

A

Ultrasound

1 MHz; 1 W/cm2 for 5 minutes each to the anterior, lateral and posterior hip for a total of 10 treatments over a 2-week period

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20
Q

True or False: Bracing is recommended as part of the first line of treatment for hip OA

A

FALSE, not recommended as part of first line treatment

21
Q

List 3 situations where it is appropriate to use bracing as an intervention for treating OA.

A
  1. Bilateral OA
  2. after exercise / manual therapy has been determined to be unsuccessful in improving function
  3. For activities that require turning / pivoting for patients with mild to moderate hip OA
22
Q

What are 3 ways glut med/min, hamstring, rec fem, and iliopsoas tendinopathy can be diagnosed?

A
  1. Resisted isometric (Strong and painful
  2. Passive stretching (PROM)
  3. Palpation (tenderness and soft tissue restriction evident)
23
Q

What 3 examination findings are present with a gluteus medius tear?

A
  1. Lateral Hip Pain
  2. Positive SLS test (asymmetric drop of the contralateral pelvis evident)
  3. Possible positive Trendelenburg during gait
24
Q

What 2 examination findings are present with a gluteus medius tendinopathy?

A
  1. Positive Trendelenburg sign

2. Pain with resisted hip abduction

25
Q

What 2 tests can be performed to identify a hamstring strain? Explain each test.

A
  1. Modified Bent knee stretch test (Rapid passive hip flexion and knee extension)
  2. Taking off the shoe test (When asked to take off the shoe in 90 degree of ER, sharp pain in biceps femoris)
26
Q

True or False: A PASSIVE approach is superior to an active approach when treating an acute hamstring impairment?

A

FALSE

An active approach is superior to a passive approach

27
Q

List 4 possible interventions to treat acute hamstring conditions.

A
  1. Relative rest and activity modification
  2. Avoid painful stretching
  3. Gradual eccentric exercises superior to conventional strengthening/ stretching exercises
  4. Trunk/hip strengthening exercises
28
Q

What are the 4 bursae of the hip?

A
  1. iliopsoas bursa
  2. trochanteric bursa
  3. gluteus medius bursa
  4. ischiogluteal bursa
29
Q

What are the 2 symptoms of hip bursitis?

A
  1. Pain

2. Swelling

30
Q

What is important to note when performing resisted isometric testing at the hip?

A
  1. Can results in false positive finding if there is a bursa underlying the contractile unit being tested (pain is reproduced when inflamed bursa is compressed)
31
Q

True or False: Friction massage is effective in treating hip tendinopathy AND bursitis.

A

FALSE

Friction massage may be an effective treatment for tendinopathy, but friction massage can aggravate an inflamed bursa.

32
Q

What muscle does the trochanteric bursa lie underneath?

A

Gluteus Medius

33
Q

What portion of the labrum is most commonly torn?

A

Anterior-superior labrum

34
Q

True or False: Labral tears are difficult to diagnose clinically.

A

TRUE

35
Q

What 3 imaging techniques are NOT effective in detecting labral tears?

A
  1. Standard MRI (poor sensitivity and specificity)

2. X-rays and CT scans will not detect a tear

36
Q

What is the gold standard imaging technique used to detect labral tears? What is the best imaging modality used to detect labral tears?

A
  1. Gold Standard: Hip arthroscopy

2. MR arthrogram is the best imaging modality

37
Q

What are the 4 symptoms associated with intra-articular lesions? (labral tears, osteochondral lesions, loose bodies , ligamentum teres rupture)

A
  1. Anterior groin or generalized hip pain
  2. Symptoms of popping, locking or snapping
  3. Symptoms of instability especially with squatting
  4. Pain produced with FABER or FADDIR
38
Q

What are the two types of femoral acetabular impingements? What structures are involved?

A

Pincer: acetabulum is overgrown causing pinching on femoral head and neck

CAM: femoral head and neck overgrow and pinch on acetabulum

39
Q

List 7 characteristics of femoral acetabular impingements (FAI)

A
  1. Anterior or lateral hip pain
  2. Pain is sharp or stabbing
  3. Pain increases with sitting
    • FADDIR Test
  5. Less than 20 degrees of internal rotation at 90 degrees of flexion
  6. Decreased range of motion into hip flexion and abduction
  7. Symptoms of popping, locking or snapping
40
Q

How is the FADDIR test performed? What does it test for? How will positive test result present?

A
  1. Passively move LE into flexion, adduction and IR.
  2. Tests for FAI
  3. Positive test reflected by increased hip/groin pain
41
Q

What 6 characteristics indicate hip joint instability?

A
  1. Anterior groin, lateral hip or generalized hip pain
    • FABER
    • FADDIR
  4. IR PROM >30 degrees at 90 degrees hip flexion
  5. Sxs of popping, locking or snapping
  6. Sxs of instability especially with squatting
42
Q

What is the consensus with regards to treating non-specific hip joint pain?

A
  1. Provide pt. education to avoid painful movement

2. Can try to normalize structure around the hip, but we can’t directly do anything to treat the condition completely

43
Q

List 3 operative procedures used to treat hip pathologies.

A
  1. Arthroplasty
  2. Arthrodesis
  3. ORIF for hip fracture
44
Q

List 3 treatments for post-op/non-operative hip/pelvis fractures.

A
  1. Respect precautions and contraindications
  2. Impairment based intervention
  3. Test, treat, retest (look for a comparable sign)
45
Q

What diagnoses can be suspected in an adult with undiagnosed hip pain? How should the PT proceed if this diagnosis is suspected?

A
  1. Avascular Necrosis (AVN)

2. If AVN is suspected, the patient should be referred to a physician.

46
Q

What are 4 possible signs/symptoms associated with pediatric avascular necrosis?

A
  1. SCFE: Higher BMI, active
  2. Presents with limp, with hip in ER
  3. Decreased passive hip IR
  4. Could present with knee pain only
47
Q

What are 6 possible signs/symptoms associated with adult/idiopathic avascular necrosis?

A
  1. Alcohol abuse
  2. Prolong steroid use
  3. Sickle cell disease
  4. Immunosuppressed (HIV)
  5. Decompression sickness
  6. Extension ROM < 15 degrees, external rotation ROM < 60 degrees, pain with IR
48
Q

List 6 strengthening exercise options for the hip.

A
  1. Glut Strengthening: Bridges, prone hip extension
  2. Abductor Strengthening: Clamshells, Side Steps
  3. Functional: Squats, Lunges, Step Ups, Step Downs
  4. Endurance: Treadmill, Elliptical, Bike, Rower.
  5. Balance: SLS on Even Surface, SLS on Uneven Surface.
  6. Core: planks, side planks, knee tucks, birddogs.

MSPT (12 decks)

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