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Musculoskeletal 1 > Hip exam/alignment > Flashcards

Hip exam/alignment Flashcards

1
Q

Hip exam: history, interview and systems review consider what?

A
  • Non-musculoskeletal: medical - visceral, systemic origin such as genitourinary can refer to hip
  • medical/mechanical: cancer, osteoporosis, fracture (either of them can produce fx)
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2
Q

L/S pathology radicular NR pain/symptoms

A
  • upper L/S L1, L2, L3, Nrs = groin and anterior thigh
  • Lower L/S L4, L5, S1 NRs = posterior hip buttock, leg, calf and foot
  • L/S is better or worse with ROM, sitting
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3
Q

Hip OA and DJD as a reason for hip pain

A
  • reason for hip pain
  • age related wear and tear
  • obesity = 1ºfactor
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4
Q

Ra as a reason for hip pain

A
  • autoimmune
  • inflammatory disease
  • joint erosion
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5
Q

Trauma or injury as a reason for hip pain

A
  • labral tear, muscle strain/tear
  • tendonopathy
  • bursitis
  • impingement syndrome
  • hip fracture (type, repair, WB status)
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6
Q

Femoral neck fracture

A
  • possible Avascular necrosis of femoral head
  • circumflex arteries (1ºsource= medial circumflex artery) suppled blood to joint capsule and femoral head
  • femoral neck fx and injury to joint capsules can disrupt blood supply leading to avascular necrosis of FH needed THR
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7
Q

Childhood hip conditions

A
  • congenital disease: hip dysplasia (malformation/alignment) – With or without dislocation abnormal Femoral head/acetabulum
  • legs-calf perches disease
  • slipped capital epiphysis
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8
Q

Legg calve perthes

A
  • osteochondrosis of femoral head
  • inflammation of bone/cartilage interface with abnormal revascularization at femoral head
  • results in a misshaped femoral head from dysfunctional bone lay down
  • avascular necrosis
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9
Q

Legg calve perthes incidence

A
  • age 3-10 M>F
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10
Q

Legg calve perthes signs and symptoms

A
  • abnormal small flat femoral head and flattened epiphysis
  • pain in hip/groin
  • antalgic gait
  • decreased ROM
  • (+) postive adduction test = pain
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11
Q

Legg calve perthes treatment

A
  • NWB Wtih crutches
  • abduction splint prevent subluxation and put joint in better alignment
  • FH in acetabulum reshapes and heals
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12
Q

Slipped capital epiphysis

general description and incidence

A
  • adolescent coxa vara
  • Age 10-16
    M>F
  • obesity is factor
  • development issue with going from coxa valga to coxa vara
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13
Q

Slipped capital epiphysis: what happens

A
  • epiphysis is subjected to greater vertical shear force
  • FH displaced down/backward
  • neck is displaced up and forward
  • can lead to avascular necrosis - seen on X-ray
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14
Q

Slipped capital epiphysis: signs and symptoms

A
  • pain in hip groin
  • antalgic gait
  • (+) trendelenberg test and gait
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15
Q

Slipped capital epiphysis: treatment

A
  • if stable
  • NWB with crutches
  • if unstable in-situ pinning
  • WB restrictions for–6 weeks
  • healing up to 6-18 months until epiphysis closes
  • percutaneously CRIF
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16
Q

Hip exam history: mechanical pathology

A
  • MOI: trauma vs gradual onset, overuse, dx of OA/RA
  • pain: type, intensity, where,
  • worsens with WB, ROM
  • symptoms pain, weakness, hypomibile, hyper mobile (not as frequent - stable joint)
  • gait abnormalities
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17
Q

Diagnostic tests and results

A
  • X-ray
  • bone scans
  • Dex-scan
  • MRI
  • NCV/EMG
  • blood tests - Rh factor (RA)
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18
Q

Observation structure vs functional findings

A
  • structural: true leg length, ante version/retroversion, femoral torsion/tibial torsion. Q-angle, pes caves rigid foot scoliosis
  • Functional: muscle imbalances of hip/knee/foot, SIJ/pelvis, spine
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19
Q

What to observe with function at the hip

A
  • ROM
  • deviations/compenstation
  • pain during LQS squat, functional movement, gait
20
Q

Angle of inclination - structure/alignment

A
  • normal; 125º
  • smaller <125º
  • larger > 125º
21
Q

Coxa vara

A
  • smaller <125 from femoral head/acetabulum to shaft
  • increase shear force on femoral neck
  • decreased length of abductors
  • decreased force production of abductors
22
Q

Coxa valga

A
  • angle between the head of the femur and shaft is >125
  • less shear force across femoral neck
  • increase length of abductors = better force production
23
Q

Normal anteversion

A
  • 15º
  • femoral neck is rotated 15ºin relation to femoral condyles
24
Q

Excessive anteversion

A
  • > 15º
  • can result in
  1. medial femoral torsion (structural change OR
  2. toeing-in compensation
25
Q

Retroversion angle

A
  • <15º
  • can result in
  1. lateral femoral torsion (structure change) OR
  2. Toeing-out compensation so that femoral head gets seated properly
26
Q

Craig’s test for ante version

A
  • palpate greater trochanter parallel to table
  • normal angle 8-15
  • measure with Goni - patella SA= straight up and MA = 2nd toe?
27
Q

Femoral medial torsion

A
  • patellas point inward
  • squinting patella and bowlegs when feet are pointing forward
  • femoral condyles go medially
  • ER hip so that patellas face forward but feet are now out
28
Q

Congential hip dislocation testing: telescoping sign

A
  • push posterior long axis of femur
  • lift femur up
  • (+) is excessive movement (hip comes out)
29
Q

Congential hip dislocation testing: ortbanti’s sings and Barlows sign

A
  • Ortolanti’s sign: abduct and ER hip will relocate (reducing click)
  • Barlow’s sign: perform IR and adduction of hip and the hip dislocated posterior (then do ortolani)
30
Q

Congential hip dislocation: limited abduction (harts sign) Cleland

A
  • passvely abduct both hips
  • (+) test = see asymmetrical abduction
  • may clunk as abducting reduces hip
31
Q

How is the hip joint a stable joint

A
  • acetabulum = deeper socket
  • expansive capsule is 1ºsupport: runs acetabulum to base of femoral neck, thinner posterior/inferior capsule = dislocated posterior)
  • extrinsic ligaments add support; iliofemoral, pubofemorla, ischiofemoral
32
Q

Normal end feels at the hip

A
  • normal capsular with some give/creep
  • flexion- soft tissue approximation
33
Q

abnormal end feels at the hip

A
  • limited capsular pattern (stiff without creep)
  • marked limitation IR, abduction
  • moderate limitation: flexion/extension
  • less limitation ER, adduction
34
Q

During AROM/PROM of the hip patient may experience

A
  • femoroacetabular impingement: pain end ROM
  • labral tear = pain or clicking
35
Q

Femoralacetabular impingements

A
  • Cam impingement: large FH, small acetabulum
  • pincer type impingement: large overhanging acetabulum
  • Combination of CAM and pincer impingement
  • **these may result in degeneration or labrum/articular cartilage and cause DJD
36
Q

Hip arthrokinematics

A
  • open chain: convex FH on concave acetabulum (spin)
  • anterior glide of FH: ER/Ext
  • Posterior glide Femoral head: Flex/IR
  • Medial glide of FH ABD
  • lateral glide Add
  • inferior glide hip flexion beyond 70
  • Closed chain: roll and slide in the same direction as pelvic motion
37
Q

open pack vs closed pack positions for the hip joint

A
  • loose pack: 30ºflexion, 30º abduction, Slight ER
  • closed pack: full extension, IR, abduction
38
Q

Joint assessment if hypomobile turn into treatment

A
  • long axis distraction
  • inferior glide - hip flexion beyond 70
  • lateral distraction; Rx with strap
  • capsule length: stretch flexion/extension, adduction/abduction, IR/ER
  • FABER (Patrick’s) test
39
Q

Strength assessment of the hip

A
  • RI of myotomes/NR scan
  • RI of hip musculature = strength status/pain or painless
  • MMT as indicated of different muscles
40
Q

Piriformis compression of Sciatic N (flail leg)

A
  • spared: ilipsoas, sartorius, quads, adductors
  • motor loss: hamstrings, adductor Magnus, popliteus, gastrocnemius, planteris, soleus, tibialis posterior, FDL, FHL
  • Sensory: lateral lower leg
41
Q
  • how does a sciatic injury occur
A
  • compression, piriformi syndrome: overuse, fall on piriformis/injection
42
Q

Femoral n. injury

A
  • sensory: femoral anterior thigh, saphenous medial leg
  • lateral femoral cutaneous n injury - lateral thigh
  • motor: quads, iliposas, sartorius,
43
Q

femoral n injury vs lateral femoral cutaneous n injury

causes

A
  • femoral nerve injury: femoral head fx, anterior hip dislocation, THR anterior approach
  • LFCN: inguinal ligament trauma, THA- anterior approach
44
Q

Lateral femoral cutaneous

A
  • neuralgia paresthetica
  • sensory only to lateral thigh to knee
  • compression under inguinal ligament
  • trauma, obesity
  • anterior approach THA
45
Q

Ilioingunial Nerve compression

A
  • compression by: TrA and IO hypertrophy in presence of L/S instability
  • sensory: groin, pain mimics hip OA
46
Q
  • Obturator nerve compression
A
  • compressed between pubic bones and obturator muscles or fracture of pelvis
  • sensory: medial thigh
  • motor: adductor weakness

Musculoskeletal 1 (42 decks)

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