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Core Practice Quiz 1 Sean > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is an alpha angle

A

angle at which the femoral head departs from its normal spherical outline

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2
Q

What alpha angle is indicative of CAM morphology

A

> 55 degrees

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3
Q

Is it possible to have CAM morphology on X-ray but no hip pain

A

Yes

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4
Q

What do you need to have a FAI diagnosis confirmed

A

CAM morphology on X-ray AND pain

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5
Q

What is a lateral centre edge angle

A

coverage of femoral head by acetabulum roof

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6
Q

Lateral centre edge angle <20 degrees

A

dysplastic (undercoverage)

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7
Q

Lateral centre edge angle 20-25 degrees

A

borderline dysplastic

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8
Q

Lateral centre edge angle 26-40 degrees

A

normal

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9
Q

Lateral centre edge angle >40 degrees

A

overcovered

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10
Q

What is FAI

A

abnormal contact between femoral head and acetabulum

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11
Q

what is the distinction between someone having CAM morphology and FAI

A

can have CAM morphology but need pain/symptomatic to have FAI

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12
Q

What is CAM morphology

A

Femoral head boney lesion

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13
Q

What is pincer morphology

A

Acetabulum boney lesion

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14
Q

2 types of FAI morphology

A

CAM and Pincer

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15
Q

Association of cam lesions and hip OA

A

association of larger CAM lesions increasing risk of hip OA

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16
Q

Management options for FAI

A

surgery only option if we want to change underlying bone morphology

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17
Q

Intrinsic factors of FAI

A

Factors originating within the patient

- Strength: improve ability to dissipate forces through lower limb

- Biomechanics: impingement occurs in positions of hip flexion, adduction and internal rotation. Reduce amount of time in certain positions to reduce hip joint loading
  • Morphology: surgery
18
Q

Extrinsic factors of FAI

A

Factors outside the person –> environmental
- type of activity
- Reducing load

  • Losing weight
19
Q

Which intrinsic factor can’t be targeted by physiotherapy

A

morphology –> surgery

20
Q

physiotherapy group vs hip arthroscopy group for FAI

A

using iHOT-33 scale found arthroscopy group had better improvement (hip impacting life less) than physical therapy group

However, neither option brings patients anywhere near back to normal

In this study –> not best exercises selected

21
Q

impairment based rehabilitation following hip arthroscopy study

A

Hip muscle strength and single leg dynamic balance reduced FAI

targeted impairments to improve patient QoL and reduce pain

Targets:
- better hip flexion range and Adduction strength were associated with better QoL
- greater strength in hip abduction and adduction = better functional performance
- better functional performance = less pain and better QoL

22
Q

In FAI impairment based rehab, better hip flexion range and Adduction strength were associated with

A

better QoL

23
Q

In FAI impairment based rehab, greater strength in hip abduction and adduction =

A

better functional performance

24
Q

In FAI impairment based rehab, better functional performance =

A

less pain and better QoL

25
Q

Which positions are provocative for FAI patients

A

hip flexion –> deep squats/deadlifts

26
Q

FAI exercise plan

A

Hip abductor
- Bridges
- Wall sits
- Banded Clam shells (not in hip flexion)
- Step up

Hip extensor
- Laying hip extensions
- Banded hip extension
- single leg RDL

Hip adductors
- Ball Holds
- Side lying holds
- Banded adduction

Hip external rotators

Trunk muscles
- One arm, one leg raise
- Pall off press
- Ball crunches

Functional progressions
- Box squat
- Bossy Ball squat
- Lunges

Plyometrics
- Step Jump
- Step Hop
- Bossy Ball Jump Squat

27
Q

What can gluteal tendinopathy affect

A

QoL, physical function, sleep

Walking up hills and activities requiring hip abductor function

28
Q

When do glute tendons become compressed

A

when hip is moved into positions of adduction and hip flexion

sitting cross legged, crossing legs while standing, shifting weight to one hip while standing, abductor stretching

29
Q

How can we avoid compression of gluteal tendons

A

minimise compression in ADLs and activity to manage GMT

30
Q

How could you differentiate hip OA and GMT

A

GMT patients will have normal hip ROM whereas hip OA patients will be limited in ROM

31
Q

Common findings in GMT patients

A

contralateral trunk lean
dynamic valgus
contralateral pelvic drop

due to weak abductors which struggle to stabilise pelvis and lower limb

32
Q

LEAP trial for GMT

A

3 treatments
- education and exercise
- corticosteroid injection
- wait and see approach

used GROC scale and pain intensity scale

Best results for education and exercise

33
Q

GMT education and advice

A

Manage compression: avoid positions where there is compression on the glute med and min tendons particularly in positions where hip is moving into hip adduction (sitting cross legged or hanging off hip) as well as in positions of hip flexion greater than 90 degrees
- Exercises prescribed shouldn’t involve moving into these positions of compression (don’t want to prescribe clams for these patients)

Manage tensile loads: speak about activity modification, reducing amount of provocative exercises they were doing to prevent further aggravation of pain and gradually building up capacity of tendon

34
Q

Exercises for GMT following 4 phase rehabilitation program (isometric, isotonic, energy storage loading and return to sport)

A

Exercises
- Bridging:
o double leg –> offset bridge –> SL bridge when patient can adequately control pelvis to perform movement

  • Functional loading
    o Single leg squat (not too much hip flexion)
    o Single leg stance progressing to step up
    o Encourage maintenance of lower limb alignment (not dropping into hip adduction or contralateral trunk lean) for both
  • Abductor loading
    once a week at high intensity
    use bands, rubber mat or reformer
35
Q

What does hip distraction in supine do

A

improves general ROM

36
Q

What does an AP glide in 90 degrees hip flexion do

A

improves hip flexion

37
Q

What does a PA glide in 90 degrees hip flexion do

A

improves hip extension

38
Q

what does a lateral glide in 90 deg hip flexion do

A

improves general hip ROM

39
Q

What does TFL/quad STM do

A

improves knee flexion

40
Q
A

Core Practice Quiz 1 Sean (6 decks)

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