ch16:pelvic/hip/thigh

Question 1

nutation vs contranutation

Answer 1

sacrum moving forward
sacrum moving back
opposite to lumbar mvt

Question 2

anteversion vs retroversion

Answer 2

anteversion= inc in the angle of torsion greater then 15deg, is evidence of external femoral torsion , toe out gait

retroversion: angle decreased, the femur internally rotates, toe in position

Question 3

hip and kn angle rel

Answer 3

coxa valga goes with genou varum
coxa vara goes with genu valgum

Question 4

Patrick test

Answer 4

FABER
- SI pathology

Question 5

gaenslen test

Answer 5

• stress SI jnt
• pt supin eon edge of table one leg is let down in hip extension
• AT stabilise opposing ASIS and applies more pressure on test leg
• +ve= pain in SI region

Question 6

thigh thrust

Answer 6

pt supine kn and hip 90 deg
- on e hand stabilise sacrum
- other applying downward pressure on leg through femur
- +ve= pain @ SI

Question 7

leg length mesure

Answer 7

ASIS to medial malleolus
- difference of 1-1.3cm is normal
- can be cause by pelvic imbalances
- must rule out true leg length discrempency

Question 8

supine to long sitting test

Answer 8

• glute bridge drop to eliminate muscle contraction
• AT passively extends leg and compare malleoli
• then pt sits up
• recheck malleoli positioning
• if malleoli appera shorter = an rot
• if lengthen = post rot

Question 9

ely test

Answer 9

tight rec fem
- prone
- if hip lifts of the table during passive kn flexion = +ve test

Question 10

kendall test

Answer 10

modified thomas variant
- rec fem contracture

Question 11

piriformis test

Answer 11

• pt sidelying
• hip flexed 60deg and kn flexed over edge of table
• AT stabilise hip and applies down pressure on kn
  +ve= pain in piriformis
  also noted possible sciatica symptoms

Question 12

hip pointer

Answer 12

• contusion of the iliac crest over TFL with an associated hematoma
• also could be tearing of external oblique m. from the iliac crest

Question 13

acute compartment syndrome

Answer 13

• progressive severe high pain
• out of proportion to injury
• inc thigh circumfereance
• pain with passive stretch
• sensory inssues

Question 14

different thigh compartments

Answer 14

ant: pain with kn flexion hip ext, weak kn ext, sensory deficit: lateral, intermediate, medial thigh, medial calf

post: pain with kn ext hip flex,
weak: kn flex, PF, great toe ext
sensory: plantar arch, dorsal foot, first web space

medial
pain with hip abd w/ kn ext
weak: hip add
sensory : prox medial thigh

Question 15

greater trochanteric bursitis

Answer 15

located btw greater trochanter, glut max and TFL
- more common in women bc of wide hips

Question 16

snapping hip syndrome types

Answer 16

external: most common, thickened iliotibial band, TFL, or glut max tendon snapping over the greater trochanter during hip flexion leading to trochantric bursitis

INTERNAL: iliopsoas tendon snapping over the ant hip capsule, lessr trochanter, femoral head, or iliopectineal eminence

INTRA-ARTICULAR: lesion of the jnt, such as labral tear, recurrent hip subluxation, osteochondral fx, or intra-articular loose bodies, can lead to the cond

Question 17

hip dislocation MOI

Answer 17

kn stricted w/ hip add leads to post direct force = post dislocation

ant dislocation= hip is abd and ext rot

post most common
signs hip flexed and int rot

Question 18

Legg-calvé-Perthes disease

Answer 18

avascular necrosis pf the capital femoral epiphysis
- non-inflamm, self limmiting
- 4-8y/o
- osteochondritis condition of the femoral head caused by diminished blood supply

Question 19

stages of legg-calvé-Perthes disease

Answer 19

1= edema dev at he synovial membrane and capsule over 1-6wks

2= necrosis of the femoral epiphysis occurs, lasting several months to 1year

3= regen/reabsorp last 1-3 years, granulation tissue invade necrotic bone, weakened subchondral support system

4= repair occurs when new,normal bone replaces dead bone. outcome relates to percentage of epiphysis involved, age of pt, an promptness of diagnosis

Question 20

s/sLegg-calvé-Perthes disease

Answer 20

• gradual onset of a limp
• mild knee pain over several months
• pain refered to the groin
• pain related to activity
• dec ROM hip abd, ext and external rot caused by muscle spasm in the hip flex/add

Question 21

thrombophlebitis

Answer 21

acute inflammation of a vein

Question 22

phlebothrombosis

Answer 22

thrombosis, or clotting, in. a vein w/o overt inflamamtory s/s

Question 23

toxic synovitis

Answer 23

• children 3-10
• transient inflammatory cond
• painful hip jnt
• antalgic gait and limp

Question 24

hip scour test

Answer 24

• identify the possible presence of osteoarthritis or damage to the articular cartilage of the hip
  +ve= pain, apprehension, reproduction of symptoms

Question 25

obturator nerve entrapment

Answer 25

- can occur where it enters the thigh as a result of pelvic tumor, obturator hernias, or pelvic and proximal femoral fx - exercise-induced, medial thigh pain from add m. originally distally along the medial thigh - pain described as vague groin or medial kn pain

Question 26

apophysitis and avulsion fx

Answer 26

- often in growth perid - sites: ASIS(sartorious), ASIS(rec fem), ischial tub(h/s), lesser trochanter(iliopsoas)

Question 27

slipped capital femoral epiphysis

Answer 27

- growth plate at the femoral head - adolescent coxa vara - 12-15 - femoral head slips at the epiphyseal plate and displaces inferiorly and posteriorly relatively to the femoral neck. -proximal femoral growth plates deteriorate - painful limp w/ groin pain - unable to hip flex to abdomen - or stand on one leg

Question 28

osteitis pubis

Answer 28

inflammatory process involving continued stress on the pubic symphysis from repeated overload of the adductor m. or repetitive running activities - gradual onset of pain in add - agravated by kicking, running, pivoting