Week 3 Lecture 3B Intra Articular Hip Disorders Flashcards

Question 1

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7-6-22 LECTURE START

Hip dysplasia – abnormal presentation of the hip

Capsular laxity – loose hip joint

Loose body – cartilage potentially floating around

Question 2

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Innervated – can hurt

Synovial fluid helps dissipate some of those forces – good for decreasing joint stress and lubricating joints

Question 3

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Majority of tears are in the anterior superior part of the joint.
From 12-3 is where (least/most) ppl tear their labrum (anterior superior labrum)

Posterolateral is less frequent – from 10-7.

Question 4

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Labral tear – cartilage is not in good shape.

People who have labral tears have more injury to their cartilage.

Question 5

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Labral tears are pretty common, can be asymptomatic. It is very common! Pretty common to have a labral tears that doesn’t bother you.

Question 6

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If you have an acetabulum that is not normal in orientation it can wear away the labrum which would make it a symptom of abnormal morphology.

Question 7

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Labral Injuries

Clinical Presentation:
Pain
(Anterior/Posterior) hip (90%) and/or groin pain
(More/Less) common in lateral or posterior regions
may radiate to knee (ant)
Anterior pain = (anterior/posterior) tear; posterior pain = (anterior/posterior) tear
Described as dull ache; intermittent sharp pain that worsens with activity - Walking, pivoting, prolonged sitting aggravate symptoms
Catching, clicking
Adductor / groin pain

Posterolateral tear will be on the posterior hip and it is less common.

Have to rule out lumbar spine – LQ screen

Prolonged sitting with the leg in hip flexion.

Answer

A

Anterior; Less; anterior; posterior;

Question 8

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Labral Injuries

Clinical Presentation:
71% (Beginning/End) of day pain

Functional limitations
Limping (89%)
Need bannister to climb stairs (67%)
Limitation of walking distance (46%) - Painful when walking too far
Sitting tolerance limited to 30 min (25%)

Question 9

Q

Most labral injuries are (traumatic/insidious).

Sitting in a car and dashboard drives femur in a posterior direction and then it subluxes out the back (posterior labral tear)

Hockey players get a lot of labral tears

Fall on flexed knee and hip – (anterior/posterior) labrum

Answer

A

insidious; anterior

Question 10

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Got it

Question 11

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Traumatic – easy to sort out – pain as a result of the injury

FAI – Bones of the femur and acetabulum – something is wrong with how they were made.

Question 12

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Abnormal shape of the bone creates the mechanical impact of the femur on the acetabulum.

As your femur comes into flexion you get the conflict between the neck of the femur and the acetabular rim. Something can be weird there between those two structures.

Cam – less space there and it butts into the acetabular rim

Too much bone on the acetabular rim and it’ll cause that mechanical conflict.

Question 13

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(Cam/Pincer) – damages the labrum more severely
(Cam/Pincer)– injure the cartilage between the acetabulum

https://www.youtube.com/watch?v=A-_r8FyJwTQ

Answer

A

Pincer; Cam

Question 14

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Cam – extra bone and then the extra bone engages in flexion

Question 15

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Got it

Question 16

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Pincer

Question 17

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Cam on the left pre op , post op on the right – took bone out (osteotomy)

Question 18

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You lose the space and the femoral head migrates. Loss of gap creates the impingement.

Question 19

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The distance is a normal offset. If the gap is small it is a problem – indicative of a cam lesion.

Question 20

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Alpha angles can impact tx
If you have extra bone, the angle will be bigger.
Measure of the sphericity of the femoral head – this is a cam

Question 21

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ALPHA ANGLE

DEFINITION: angle formed by: (1) a line parallel to the femoral neck axis and (2) a line from the center of the femoral head to the transition of the femoral head into the femoral neck
ABNORMAL: if > _ degrees then associated with CAM type femoral acetabular impingement

Question 22

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If the number is big, too much acetabular coverage.

Question 23

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Center Edge Angle

The acetabulum typically overhangs the femoral head.
NORMAL: The degree of overhang typically ranges between _ to _ degrees and is termed the Center Edge Angle (Angle of Wiberg).

OVER COVERAGE (pincer/cam):  > _ degrees
UNDER COVERAGE: Smaller Center Edge Angles - < _  degrees have been associated with congenital dislocations (under coverage)

Less than 20 there is not enough coverage and the hip can be unstable.

Answer

A

30 to 40; pincer; 45; 20;

Question 24

Q

Femoral Neck

Angle of Inclination: Angulation of the femoral neck in the frontal plane
Facilitates motion by orienting the femoral shaft more lateral and provides a greater lever arm for the hip abductor muscles

Values/Variations:
Normal: approximately _ degrees
Coxa Valga: Angle of Inclination > _ degrees
Coxa Vara: Angle of Inclination < _ degrees

This impacts the way the femoral head sits in the acetabulum . The way the femoral head sits in the acetabulum will be different.
Small contact area – degeneration of their joint OR can be unstable – variations ^^

Answer

A

125; 135; 120;

Question 25

Q

Femoral Neck II

Angle of Declination (Torsion / version):
Angulation of the femoral neck in the transverse plane relative to the femoral condyles

Values/Variations:
Normal Adult Value: (-°)
Increased anteversion (> _ °)
Retroversion (< _°)

Answer

A

8-15; 15; 8

Question 26

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Femoral version

Question 27

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People with anteversion will be toe (in/out)

People with retroversion will be toe (in/out).

Question 28

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Excessive anteversion – feet straight ahead won’t put femoral head smoothly in the acetabulum – only comfortable when toe in.

Question 29

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Got it

Question 30

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SCFE (slipped capital femoral epiphysis) – femoral head comes down in an inferior direction and reduces the head-neck offset

AVN – Avascular necrosis

Question 31

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Got it

Question 32

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Got it

Question 33

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Anteverted – to the front

Question 34

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Acetabular retroversion may lead to .. (Cam/Pincer) impingement and a + cross over sign.

Question 35

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Anterior rim will be more prominent in retroversion. Anterior rim crosses over posterior rim. A retroverted acetabulum creates the pincer because you have more coverage on the front and will bang the anterior wall of the acetabulum.

Question 36

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Limited in hip (flexion/extension) for retroversion

Question 37

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Coxa profunda – (shallow/deep) acetabulum . The acetabulum got really deep. That creates a (cam/pincer) all around the acetabular rim.

Answer

A

deep; pincer

Question 38

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If you have one of these hip dysplasia’s it will wear out quicker

Question 39

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Terminology

Under-coverage:
Excessive acetabular (anteversion/retroversion)
Coxa (Valga/Vara)
Developmental Dysplastic Hip DDH - (shallow/deep)acetabulum

Over-coverage
Acetabular (anteversion/retroversion)
Coxa Profunda- Acetabular fossa is too (shallow/deep)

Answer

A

anteversion; valga; shallow; retroversion; deep

Question 40

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Something wrong with the makeup of the cartilage – primary

Goal for FAI surgery is to preserve the hip joint

Question 41

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AIIS – Rectus femoris attaches to the AIIS.

Question 42

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IFI – if you go into (flexion/extension), (add/abduction), and (IR/ER) , you can impinge the lesser trochanter on the ischial tuberosity. That will be the test to look for it as well.

Fx – trauma that changes the position of the lesser trochanter on the femoral neck.

Answer

A

extension; adduction; ER

Question 43

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Got it

Question 44

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Iliopsoas passes in front of the anterior hip.

The iliopsoas is 1-3 o clock on the clock face and passes in front of the anterior labrum

Question 45

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L – labrum
C – capsule
IP – iliopsoas

They are right on top of each other and when you get inflammation in that space you get development of adhesions. When you flex your hip everything will be stuck together and it hurts.

Question 46

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Gpt ot

Question 47

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People with groin pain have poor trunk stability

When you initiate limb movement, first muscles to activate are the multifidus and TA.

Question 48

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When you stabilize your core it makes your hips work better.

Question 49

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Etiology - NM Control

(Short / increased tone / PAIN/ Weak / poorly recruited) - Soft tissue mobilization
iliopsoas
Adductor group

(Short / increased tone / PAIN/ Weak / poorly recruited) - Strengthening 
Gluteus max
Gluteus medius
TA
Obliques

Answer

A

Short / increased tone / PAIN; Weak / poorly recruited

Question 50

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Got it

Question 51

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Log roll test

Feeling for how much resistance is there.

Passive IR and ER of hip
With external rotation of the hip in neutral, the (iliofemoral/ischiofemoral) ligament and (anterior/posterior) capsule are the limiting structures and are, therefore, being assessed (Neumann). With internal rotation, the end-feel can be assessed for the (iliofemoral/ischiofemoral) ligament and (internal/external) rotator muscles as well.

Answer

A

iliofemoral; anterior; ischiofemoral; external;

Question 52

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Examiner manually rotates hip into IROT and then releases the limb allowing it to passively rotate externally.
+ test = when there is external rotation (below/beyond) 45° from vertical in the axial plane on the affected limb, and it lacks a definitive mechanical endpoint.

Should flop back to EROT

Question 53

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(Hyperflexion/Hyperextension) + (IR/ER) - Looking for apprehension

Answer

A

Hyperextension; ER;

Question 54

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Posterior apprehension test

(Extension/Flexion), (Abduction/Adduction), (EROT/IROT) – posterior force

+ = Pain or apprehension

Answer

A

Flexion; Adduction; IROT;

Question 55

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Stability Issues

Factors contributing to reduced stability:
Capsule and ligament laxity
Bone Architecture:
(Increased/Decreased) center edge angle (below 20 degrees)
Increased acetabular (anteversion/retroversion)
(Shallow/Deep) acetabulum
Coxa (vara/valga)

Clinical Issue:
The hip is an inherently stable joint. A relatively small amount of instability in the hip may prove problematic versus a joint such as the shoulder.
Hip is a weight bearing joint

Anteversion- more open in the front so it will be less stable

Instability of the hip can create problems because you have to WB on it. A little bit of instability can cause a big problem.

Answer

A

Decreased; anteversion; Shallow; valga;

Question 56

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Association between Non-Contact Posterior Hip Subluxation and Femoroacetabular Impingement

Decreased functional flexion of the hip due to FAI
(Cam, pincer, or both) - Can cause (anterior/posterior) hip subluxation

Subluxation – as the femur bangs into the acetabular rim it can sublux posteriorly. Added hypermobility increases risk of subluxation.

Answer

A

posterior;

Question 57

Q

Clinical Exam- Intra articular hip pain Subjective

Pain with (minimal/prolonged) sitting
Anterior hip pain with active hip (flexion/extension)  - End range pinch or pain
Pain with (flexion/extension) phase of gait
Sharp pain, clicking, locking with pivot movements
Groin pain (adductors)

Questions:
History of low back pain / SIJ pain ?
Traumatic or insidious onset?
Imaging?

Observation: pattern recognition

Anterior problem – pain with extension when walking because the femoral head goes anteriorly when you go into extension

History of low back pain – if you bang the femur in the acetabulum you won’t have enough space to keep doing that over and over again. It can create excess motion in the pelvic ring.

Imaging – guides what you do and gives a tx plan.

Pattern recognition – core, gluteal muscles, adductors, decreased tone, hip flexors, etc

Answer

A

prolonged; flexion; extension;

Question 58

Q

Lot of ER, not a lot of IR – Femoral (anteversion/retroversion)

Answer

A

retroversion;

Question 59

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Femoral (anteversion/retroversion) – Lot of IR, but not ER

Answer

A

anteversion

Question 60

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Tilts:
APT (increases/decreases) coverage
PPT (increases/decreases) coverage (reduce contact of femur on acetab rim).

Will impinge (earlier/later) in hip flexion when in APT.

Pelvic Rotation:
Toward (symptomatic/asymptomatic) side

Answer

A

increases; decreases; earlier; asymptomatic;

Question 61

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Shallower squat depth because it hurts

Long strides hurt in these pts.

Question 62

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Trunk rotation to the right but he is actually side bending – that is a compensation – not a lot of rotation in their trunk. Need to improve their trunk mobility