Exam III Study Guide

Question 1

HIP OA RISK FACTORS

Answer 1

Age greater than 50y
Male gender
Acetabular dysplasia

Question 2

Hip OA clinical manifestations

Answer 2

Moderate anterior or lateral hip pain in weightbearing
Morning stiffness less than 1 hour

Question 3

AVASCULAR NECROSIS RISK FACTORS

Answer 3

Age 30-60 y
Male gender
Long term steroid use
Trauma
Alcoholism

Question 4

AVASCULAR NECROSIS CLINICAL MANIFESTATIONS

Answer 4

-Antalgic Gait
-Pain in the groin to medial knee
-Throbbing deep hip pain

Question 5

Labral tear risk factors

Answer 5

Sudden onset-External rotation force in a hyperextended position
Traumatic onset- MVA, Fall
Gradual onset-Microtrama
History of Hip dysplasia

Question 6

labral tear clinical manifestations

Answer 6

-Anterior hip and groin pain
- Dull ache which increases with activities such as running, brisk walking, twisting movements of the hip or climbing stairs
-Antalgic gait

Question 7

TROCHNTERIC BURSITIS RISK FACTORS

Answer 7

Often idiopathic, repetitive microtrauma ie. Running, cycling

Question 8

TROCHNTERIC BURSITIS CLINICAL MANIFESTATIONS

Answer 8

-Unilateral hip pain however able to walk

Question 9

FEMOROACETABULAR
IMPINGMENT SYNDROME (FAI) RISK FACTORS

Answer 9

-motion-related clinical disorder of the hip involving premature contact between the acetabulum and the proximal femur
-Exposure to repetitive and often supraphysiologic hip rotation and hip flexion during development in childhood and adolescence (e.g. hockey, basketball or football).
-Family history (siblings)

Question 10

FEMOROACETABULAR
IMPINGMENT SYNDROME (FAI) CLINICAL MANIFESTIONS

Answer 10

-stiffness and pain in the hip and/or groin
-aggravated with acceleration sports as well as squatting, climbing stairs and prolonged sitting

Question 11

Obturator nerve entrapment risk factors

Answer 11

Idiopathic

Question 12

Obturator nerve entrapment clinical manifestations

Answer 12

• Medial thigh or groin pain
  -Weakness with leg adduction
  -Sensory loss in the medial thigh of the affected side

Question 13

Hip OA special tests

Answer 13

-FABER
-Hip IR and flexion 15 degrees differ from uninvolved hip
-Arthritis Cluster
-balance assessments

Question 14

avascular necrosis special tests

Answer 14

-Limited hip internal rotation, flexion, and abduction AROM and PROM

Question 15

Labral tear special tests

Answer 15

-IR-Flex-Axial Compression maneuver
-FAIR
-FADDIR
-Posterior Labral Tear
test
-Thomas test

Question 16

TROCHNTERIC BURSITIS special tests

Answer 16

• Pain with palpation greater trochanter

Question 17

FEMOROACETABULAR
IMPINGMENT SYNDROME (FAI)
special tests

Answer 17

-FADIR
-Diagnosis dependent on history

Question 18

obturator nerve entrapment special tests

Answer 18

-Pain with extension and ABD of the hip
-decreased sensation obturator nerve distribution

Question 19

Prone Instability Test

Answer 19

Patient lies prone over end of table with feet resting on floor
PT provides PA pressure to the lumbar spine at each level looking for provocation of pain
The patient is cued to lift legs off of floor
PT provides PA pressure to the lumbar spine at each level looking for provocation of pain

Positive: If pain is reduced in second movement

Question 20

Manipulation Test Item Cluster

Answer 20

-Duration of symptoms <16 days
-No symptoms distal to knee
-Lumbar hypomobility
-At least one hip with greater than 35 degrees IR
-FABQ-W less than 19

4 of 5 predictors and no contraindications= manipulate

Question 21

Coordination Impairment/ Stabilization Test Item Cluster

Answer 21

-Age less than 40
-Positive prone instability test
-Aberrant movement with ROM
-SLR greater than 90 degrees

3 or the 4 findings= coordination (multifidi and transverse abdominis)

Question 22

Direction Specific Exercise (Flexion)

Answer 22

Mainly older patients with spinal stenosis
LE symptoms come on after standing for walking for certain amount of time
Sitting improves symptoms
Flexion activities improve symptoms

Question 23

Direction Specific Exercise (Extension)

Answer 23

Symptoms distal to the buttock
Symptoms centralize with lumbar extension
Symptoms peripheralize with lumbar flexion

Question 24

Inferior glide

Answer 24

improves flexion and abduction

Question 25

Posterior glide

Answer 25

improves flexion and IR

Question 26

Anterior glide

Answer 26

improves extension and ER

Question 27

Scour test

Answer 27

for arthritis, Patient is in supine close to edge of table. The examiner flexes hip to 90 degrees. Axial compression is applied as hip is moved into flexion and ADD and again in flexion and ABD

Question 28

Patrick test/ FABER (flexion, ABD, ER)

Answer 28

Patient is supine. Hip is placed in ER and horizontal abd with crossing of foot on opposite thigh. The examiner stabilizes the pelvis and applies a downward force through knee Positive test= Anterior pain or discomfort +LR 5.4, -LR 0.5 Hip Instability Positive test= SI area pain or discomfort +LR 1.37, -LR 0.64 Positive test = decreased ROM +LR 1.9, -LR .61 Hip OA

Question 29

Arthritis Cluster

Answer 29

Squatting aggravates symptoms (+LR 6.1, -LR 0.79) Pain with active hip flexion (lateral hip /groin) Pain with active hip extension (lateral hip/ groin) Scour tests with ADDuction causes lateral hip pain or groin pain (+LR 2.4, -LR 0.51) Passive internal rotation ROM ≦ 25 degrees

Question 30

Trendelenburg's sign

Answer 30

Position: Close to table (something to hold onto), standing on one leg (involved leg) and raise opposite leg (non-involved leg), i.e. knee toward chest. Test: Clinician observes the response. Stance leg is the leg being assessed. (-): Normally, pelvis on opposite side should rise. (+): Pelvis drops on opposite side. -> Indicates weak gluteus medius or an unstable hip.

Question 31

Internal rotation-flexion-axial compression maneuver

Answer 31

for labral tear Patient is supine. Examiner flexes and internally rotates hip. Then applies axial compression. Provocation of pain is positive for suspected labral tear

Question 32

Flexion-adduction-Internal rotation test/ Click test/ (FAIR?)

Answer 32

Patient is sidelying. Examiner stabilizes pelvis while moving patients hip through 50-100 degrees flexion with Adduction and IR. Presence of a click is positive for possible labral tear. Reproduction of sciatica- Piriformis syndrome?

Question 33

Posterior Labral Tear Test

Answer 33

Position: Supine, place test leg (start position) into full Flex, IR, & Add. Test: Clinician Ext hip with ER & Abd. (+): Pain or Reproduction S/S with or without “click”. Groin pain or patient apprehension. -> Labral tear, anterior hip instability, or Posterior-Inferior Impingement.

Question 34

FADIR – Flexion, Adduction, and IR Test

Answer 34

for FAI, Position: Supine, place test leg (start position) into full Flex, ER, & full Abd. Test: Clinician Ext hip with IR & Add.. (+): Pain or Reproduction S/S with or without “click”. -> Anterior-Superior Impingement, OA

Question 35

Long stride walking special test

Answer 35

for Ischiofemoral Impingement, Patient is asked to walk with long strides. Pain at terminal extension Positive: Pain relieves when a=walking with hip ABDucted

Question 36

Ischiofemoral impingement test

Answer 36

Patient is sidelying with affected leg on top Examiner passively extends hip

Question 37

Patellar-Pubic-Percussion Test

Answer 37

for fracture, Patient is supine Therapist taps one patella at a time while auscultating pubic synthesis with a stephescope Positive test= diminution of percussion noted on affected side

Question 38

Thomas test

Answer 38

Muscle length/provocation test for labral tear The patient should be in the supine position. Have the patient flex both knees and hips by pulling the knees to the chest and holding it there. This will cause the lumbar lordosis to straighten out. Place your hand under the patient's spine to identify lumbar lordosis. Straighten out and lower one leg.

Question 39

Ely test

Answer 39

for muscle length, Patient is prone with passive knee flexion

Question 40

Ober test

Answer 40

for muscle length, Patient is sidelying. Examiner flexes knee to 90 degrees and ABD and Extends hip until it is in line with trunk. Slowly allows hip to ADD while maintaining pelvis in neutral.

Question 41

True Leg Length measurement

Answer 41

Position: Supine, set pelvis square (patient lifts pelvis then back down), legs about 15 to 20 cm (5-8 inches) apart & parallel. Test: Clinician use tape measure to measure from ASIS to medial malleolus OR ASIS to lateral malleolus (less affected by muscle mass). Normal: A slight difference of 1 to 1 ½ cm (0.4 to 0.6 inch) is normal; but can cause S/S. (+): Different levels indicate asymmetry.

Question 42

Sacroiliac Pain Provocation Tests

Answer 42

3 tests positive indicates SI dysfunction Distraction Thigh Thrust Gaenslen Sacral thrust Compression

Question 43

Distraction test

Answer 43

Hands over ASIS with force directly posterior

Question 44

Thigh thrust test

Answer 44

The sacrum is fixated against the table with the left hand, and a vertically oriented force is applied through the line of the femur directed posteriorly, producing a posterior shearing force at the SIJ.

Question 45

Gaenslen

Answer 45

The pelvis is stressed with a torsion force by a superior/posterior force applied to the right knee and a posteriorly directed force applied to the left knee, do not do during pregnancy

Question 46

Gillet Test

Answer 46

Patient stands with feet 12 inches apart Palpate S2 with one hand and iliac spine with other Patient flexes hip and knee on side of iliac palpation Positive: NO movement of PSIS in a posterior direction compared to S2

Question 47

Standing Flexion Test

Answer 47

Patient is standing Palpate PSIS Bilateral Patient forward flexes as far as possible Positive for hypermobility if one PSIS (+) moves further cranially

Question 48

Supine to long sit

Answer 48

Patient supine Palpate medial malleoli and note leg length Patient long sits Note leg length Positive if leg length changes

Question 49

Prone knee bend

Answer 49

Patient in Prone with knees extended. Assess leg length Passively flex knees to 90 degrees. Assess leg length Positive if leg length changes

Question 50

Neuro screen for diagnosing lumbosacral radiculopathy

Answer 50

Reflexes Weakness Sensory +SLR

Question 51

Delitto PT classification system

Answer 51

Mobilization/manipulation Direction specific repeated exercise Stabilization Traction

Question 52

Alrwaily PT classification system

Answer 52

movement control