Exam 2 - Pelvis and hip 3

Question 1

what is the etiology of hypermobility in the LE

Answer 1

traumatic: fx, lig treat, labral tear

atraumatic: extreme motions in sports, labral tear with FAI/IPI, systemic connective tissue disorder

Question 2

describe what kinds of bone abnormalities can lead to hypermobility in the hip

Answer 2

shallow acetabulum
inferior acetabular insufficiency
excessive femoral version or torsion
excessive femoral neck angle

Question 3

in the transverse plane, excessive anteversion causes toeing (in/out)

Answer 3

toeing in

Question 4

in the transverse plane, excessive retroversion causes toeing (in/out)

Answer 4

toeing out

Question 5

describe coxa valga

Answer 5

frontal plane

larger angle of inclination
leads to genu vara or bow legged position

Question 6

descrive coxa vara

Answer 6

smaller angle of inclination
leads to genu valga or knocked kneed position

Question 7

list the risk factors of hypermobility in the hip

Answer 7

genetics
injury
pt activities: running, dance, any activity that involves rotation, flexion, hyperextension

Question 8

what are the symptoms of hip hypermobility

Answer 8

anterior groin or lateral hip pain
popping, locking, snapping present
feeling of instability especially when squatting

Question 9

what would you expect to find in your scan with hip hypermobility

Answer 9

ROM: hip R > 30 at 90 flx
CM: possible inconsistent block
Special: (+) hip apprehension, abnormal femoral version/torsion

Question 10

what is hip apprehension test

Answer 10

pt prone, move hip into ext with ER and ABD while applying anterior inferior force onf emur

Question 11

what is the focus of PT for hip hypermobility

Answer 11

primary focus is on cartilage integrity and stabilisation

Question 12

what is regional interdependence

Answer 12

theory that different body regions are biomechanically and neurophysiological interdependent and impairment in one region can contribute to impairment in another

Question 13

what is the prominant innervation to the L4-S1 Z joints

Answer 13

L4 dorsal rami

Question 14

what is the predominant and the most consistent innervation to L4-S1 discs

Answer 14

L1,2 dorsal root ganglia and L4 and L5 sinuvertebral nerves

Question 15

what is the primary innervation of the iliolumbar ligaments

Answer 15

L1-4 spinal nerves

Question 16

if any of the L4-SS1 joints are persistently hypermobile/unstable, what muscles groups are more likely to excessively recruiter d/t the predominance of L1-4 innervation and sensitization

Answer 16

hip flexors (L1,2)
hip adductors (L3)
knee extensors (L3,4)
ankle dorsiflexion (L4,5)

Question 17

what muscles are hip flexors

Answer 17

iliopsoas (L1-4)
iliocapsularis (L2-4)
rectus femoris (L2-4)

Question 18

what does the iliopsoas attach to

Answer 18

iliocapsularis

Question 19

what does the iliocapsularis attach to

Answer 19

iliopsoas, anteromedial capsule, rectus femoris

Question 20

what does the rectus femoris attach to

Answer 20

capsule

Question 21

what does the capsule attach to

Answer 21

labrum

Question 22

what is the etiology of the L4-S1 regional interdependence

Answer 22

L4-S1 hypermobility/instability
most common segments

Question 23

describe the pathomechanics of L4-S1 regional interdependence

Answer 23

inhibition of hip extensors and abductor

Question 24

what is the effect of excessive recruitment of the hip flexors that attach to the capsule

Answer 24

excessive traction on antmed portion (3 or 9 o’clock position) of capsule and labrum

may lead to labral irritation without boney changes like with FAI

Question 25

what is the effect of the inhibition of hip extensors and abductors

Answer 25

imbalance limites optimal axis of motion and joint support easily overworked d/t lowered recruitment so overuse/lower supply occurs

Question 26

why do the hip extensors and abductors become hypertonic with L4-S1 regional interdependence explain how a pt would report this

Answer 26

d/t being overworked even without overuse pt would report as tightness that stretching can relieve for a short time, but tightness always returns

Question 27

what muscle hypertrophies in those with LBP what does this indicate

Answer 27

iliopsoas indicates continued and excessive recruitment

Question 28

what is a consequence of excessive recruitment of iliopsoas d/t L4-S1 regional interdependence

Answer 28

increased anterior shear most often occurring with lumbar hypermobility/instability

Question 29

what is iliopsoas impingement

Answer 29

impingement without dysplasia or bony changes

Question 30

what is the etiology of iliopsoas impingement

Answer 30

not fully clear conditions that lead to excessive hip flexor recruitment lumbar hypermobility/instability with regional interdependence

Question 31

what are the symptoms of iliopsoas impingement

Answer 31

like FAI possible lumbar hypermobility/instability symptoms if aggravated

Question 32

what ROM would you expect with iliopsoas impingement

Answer 32

like FAI with: IR limitation @ 90 flexion, elasic end feel hip maltracking @ 90 flx

Question 33

why is IR limited with iliopsoas impingement

Answer 33

inhibition and hypertonicity of extensors or primarily glute max which is also the main ER at 90 flx

Question 34

what is the cause of hip maltracking @ 90 flexion

Answer 34

inhibition and hypertonicity of piriformis that is an abductor at 90 flexion

Question 35

what would you expect to see with RST with iliopsoas impingement

Answer 35

possible hip ER inibiiton at 90 flezion d/t glute max inhibition possible inhibition of extensors, quad dominant squatting pattern possible inhibited abductors

Question 36

what would you expect to find in the neuro scan for iliopsoas impingement

Answer 36

possible hypersensitivity

Question 37

what would you find during your palpation exam for iliopsoas impingement

Answer 37

TTP over anterior hip region at 3 or 9 oclock position depending on hip

Question 38

what would you find in the throacolumbar scan and biomechanical exam with iliopsoas impingement

Answer 38

possible lumbar hypermobility/instability

Question 39

what is the PT rx for iliopsaoas impingement

Answer 39

culprit rx - lumbar hypermobility/instability victim rx - like FAI rx

Question 40

what would be the MD rx for iliopsoas impingement

Answer 40

iliopsoas surgical partial release does not treat the culprit